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Burnett County A10 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ' m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3_ 0 — <br /> o <br /> TO HE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 V <br /> 0 <br /> regulations of the State of Wisconsin. m <br /> c '? <br /> n O <br /> OWNER � <br /> TELEPHONE JGbL F soLO m o.v.�o.0 6 8':F-02 � 63 s�7 <br /> ADDRESS ;-) 3 ,� <br /> oC J <br /> MERGENCY/FIRE NUMBER '1 7 170 ROAD NAME N. <br /> 1 <br /> EGAL DESCRIPTION (see tax receipt) I <br /> ONTRACTOR Gjgc�ne 1—fcK4?, <br /> u <br /> IPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O <br /> n L) <br /> WITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a o �+-- <br /> J <br /> p <br /> -RUCTURE/ADDITION USE: FtppfT/OA) 7Z) FwS77YVC CHSlN <br /> v <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) o ® / <br /> 4RECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) ? !' <br /> Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). <br /> !. Show the location of the well (W),septic tank (ST), and drainfield (DF). 3 <br /> J. Show dimensions in feet ofthefollowing:(a) buildingto all lot lines,(b)buildingto center line of road,(c)building <br /> measurement to the ordinary high water mark of lake,stream, or river. Q <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. Q o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I m <br /> �I z `o <br /> PLOT PLAN ° a <br /> wee r J jf�{ mit R-G <br /> ��i5( xis c o <br /> H J <br /> - <br /> batt <br /> P�zfn� 176 <br /> I �sf I <br /> I ) <br /> SO �J <br /> Vf �w e <br /> �QS �gac��� <br /> TOp <br /> f}DDi7'lON COUSISU OF" <br /> I) QRSEWIENT GGNDL2 H6-4p' OF EX/sn� GAH/N 1s x <br /> plus I 1q, ander NEW parWO N <br /> I �' X (9 R06IVt ijaDF� 7-D WEST S[cfe <br /> Grauna G�ue� EDRoom 9 � �MNr-DDov <br /> 2� - 6� t�sr <br /> 3) 2 SOLI' 5t9n4F geeEfl {�S $ASF n»e �r3ttrr� ; pK. ZaN eFz <br /> CONDITIONS OF PERMIT: o m Lon.: -R C8 o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N M <br /> a. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o ff ' ro <br /> o : aff <br /> �i <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- : er m n T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B o : p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 003 <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 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 o <br /> access to the above described premises at any reasonable time for the purpose of inspection. r ; 3 0 <br /> m 0 A N <br /> NS : <br /> SIGN HERE '^` s <br /> (signature t wn q contractor) o <br /> 'NG ADMINISTRATOR – —� 0 <br /> T WNSHIP PERMITS MAY BE REQUIRED ) o a m <br /> 0000001-100 r/) <br />