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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m u c 0 <br /> APPLICATION FOR — LAND USE — PERMITSf <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and rA� <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requireme its of the m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. a m O <br /> OWNER C-,- - TELEPHONE y/ 3 n E <br /> ADDRESS ,�.- S (•ti 5, R 'c�S 7 1 <br /> EMERGENCY/FIRE NUMBER13 ROADNAME f <br /> ifrsruR r 10/6- 737 FV3 64 3 TYeo Ria <br /> LEGAL DESCRIPTION (seataz receipgA` E' PCC. V�U,/4r <br /> .a c9J,j'p P L 'CS/ <br /> ,ry .v r./ .i J- ' �-"r - <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE (,-"'ADDTION p <br /> n O T <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o L <br /> o _. <br /> 7 " r <br /> STRUCTURE/ADDITION USE: L <7 ',x, 0 0 <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) <br /> Z <br /> 0 o t1 <br /> a <br /> r J <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). <br /> 2. Show the location of the well (N),septic tank (ST), and drainfield (DF). r <br /> 0 <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building yI <br /> measurement to the ordinary high water mark of lake,stream,or river. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and X <br /> dated by the owner. 110c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST B FOR ONSITE VERIFICATION BkFORE A PERMIT CAN BE 13SUED. 7I 3 rn <br /> PLOT,PLAN j�. / o 'n <br /> V h M H Z <br /> A° N' > g o ' &7 of m <br /> L }1� <br /> 00 <br /> lot ? I <br /> Z- <br /> rj <br /> o Fy t� Il" <br /> �/ v bEv��as�vm <br /> m <br /> S o. B — <br /> CONDITIONS OF PERMIT: w <br /> I,N �� �� (' N.: Z c 8 g ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WI TH REOUIR9MENY$ WITHIN 60 DAYS OF PERMIT ISSUANCE. c 6'.0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> In <br /> �i <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of y knowl- o !E <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of a I informs- E «m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that his Infor- t <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue i permit. I gr$ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing n this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. m <br /> SIGN HERE -�"" "^ 4 <br /> (signs 1 owner o b Idingicon)raetod t -- (tlYts) <br /> ZONING ADMINISTRATOR - 2 <br /> �L ,tV r - <br /> MAR 201915 " <br /> TOWNSHIP PER � A I '� ���$���}� -Mn <br /> 1�, <br />