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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ; m a 0 <br /> APPLI ATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � m <br /> located as shown herein. The urdersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordina ice, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin, <br /> /faun PLO f'horle <br /> TELEPHONE <br /> OWNER n `�\ <br /> NoR m h T s© Mother / 6 YJ- Sa3 m (A <br /> ADDRESS 1625 7y Gd 01 r17- Lan e- G r4nT's brtr W / <br /> EMERGENCY/FIRE NUMBER la5711 ROAD NAME C dCLh01 2. J �� <br /> N1s5ThRY q7/7Y79, S.iO T87/R164. acre pcL 7 <br /> LEGAL DESCRIPTION (see tax receipt) :T-7, /8, as ,6WE16 40-r C5M C 1.,6T <br /> ye_rher wrrk esAIr `V7115 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o f <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> STRUCTURE/ADDITION USE: Q[t CL 4 57-oY add,-rick 4oUin /P66M ort T-6 - LLT#LiTY � <br /> Home/Cabin;Commercial Business; Bedroom;Deck; etc.) Ro6ilA be/orU - o o ^i <br /> a <br /> m <br /> RedeSic <br /> /n -rhe 77TC <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 /> r <br /> 2. Show the location of thew II (W),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions in feet of It efollowing:(a) building to all lot lines,(b)buildingto center line of road,(c)building <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 9 <br /> dated by the owner. 0 0 <br /> NOTE. BUILDING/STRUCTURE L TIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I 3 m <br /> c <br /> Z c <br /> PLOT PLAN 0 n <br /> Trades R 1 J c r In o <br /> C I <br /> W ? E 1 M �l r <br /> S <br /> 1 <br /> a" O O <br /> �1 'Add //' ` G4St KtxS Iy\ ,' <br /> r 5 0+ 0. 1 <br /> .v E 3 _ foP <br /> 1 <br /> Cnb,n 0. <br /> 45 - <br /> O <br /> a <br /> 0 <br /> IS' Mai. I. 9 <br /> I <br /> I SYSR M CSO <br /> � I <br /> C` Pell' f <br /> 0jr�20n, O� <br /> IJ n 1 Q.I_J�-� 6e '(la+� rn I E45f Merl? Rod'dt <br /> J JyCCGtvTl ./ \ M r�m_v�n ern a0 -V <br /> arm -g .0 a m <br /> KI'Orl UE m 33 �a N c m M <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 0 .Z <br /> 2. REMOVAL OR CUTTING F TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ �, =r^r 1 <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. . . . 0 �' p <br /> 0: o C <br /> I declare that this application(i cluding any accompanying schedule)has been examined by me and to the best of my knowl- o : m ' <br /> edge and belief it is true,come t and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- «r m r m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 8 is p <br /> mation 1 am providing will be elied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $`I3 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have O N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE <br /> (sit ure f owner or b g contract (date) <br /> �j <br /> y <br /> ZONING ADMINISTRATOR <br /> i . 'I m <br /> TOWNSHIP PERMITS MAY BE REQUIRED U�I. o m v m <br /> � 000o m ® fr% <br /> I � <br /> i � <br />