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Burnett Ceunfy 7410 Co. Rd. K, No. 102, Siren, WI 54872 f <br /> OffiCO Of Zoning Administrator ti <br /> APPLICATION FOR — LAND USE — PERMITS f <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work de cribed and Q <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirerT ients of the o c <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other a <br /> regulations of the State Of Wisconsin. PPlicable County Ordinances and t laws and . <br /> OWNER /C / TELEPHONEo. ra F <br /> 6/z-690-7-3 y <br /> ADDRESS O <br /> � 3 0/ � SSM �LitCc NytrvSvll_L� X337 <br /> EMERGENCY/FIRE NUMBER of q S--['e ROAD NAME l �„�� <br /> IS `1r <br /> I T L 4 <br /> LEGAL DESCRIPTION (see tax receipt) �t. <br /> CONTRACTOR SOL F I <br /> TYPE OF PERMIT(S): DWELLING/BUILDINGj— <br /> GARAGE/ACCESSORY STRUCTURE ADDITION <br /> 0 <br /> SANITARY PRIVYFILLING/GRADINGO x� <br /> CAMPING UNIT SUBDIVISION – O <br /> STRUCTURE/ADDITION USE: aSeASsvS Qpe(A, Opi b A) <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc) o ° <br /> v <br /> Z Q <br /> o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) a <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 (W),septic tank (ST),and drainfield (D17. <br /> 3. Show dimensions in feet clothe following:(a)building to all lot lines,(b)building to center line of road,(c building <br /> measurement to the ordinary high water mark of lake, stream,or river. fl <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sl ned and 9 <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. O c <br /> PLOT PLAN OR Z m <br /> O n <br /> Sf--L A iTACIf(>A m 9� <br /> v0 0 <br /> r+ C I <br /> SES Pf/Cmrf 7$ 13 Tit Oel6 � f�GMt m <br /> r, <br /> I <br /> s <br /> r g <br /> o <br /> N <br /> O <br /> o <br /> 2 <br /> N � <br /> r <br /> J <br /> lt� Z <br /> F <br /> DnF m <br /> CONDITIONS OF PERMIT: m p�,� _ n�'+ g,m <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. ? a 8 g� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ° f *2 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Ng In <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and 10 the best of my nowl- 0 , i Q X - - m <br /> P . [ C <br /> edge and belief it is true,correct and complete.I acknowledge That I am responsible for thedetail and accuracy of all informa- <br /> tion contained in this application(including any accompanying chedulel.and I further declare that I recognize that this infor- <br /> motion I am providing will be relied upon by the County of Wiftsconsin in determining whether to issue a rmit. I <br /> further accept all liability which may be a result of the Count <br /> plication. I agree to permit county Officials charged with adm relyin n this information I am providing int is so <br /> access to the above described premises at an reasonable ti fort pu r or other authorized person t have <br /> y Y tion. . <br /> g of rdtnances '. <br /> of inspection. <br /> SIGN HERE <br /> (sign u of owner ilding contr E (date) <br /> ZONING ADMINISTRATOR <br /> i Of <br /> i i gi <br /> TOWNSHIP PERMITSw1AY IE REOUIR <br /> $ 88888 <br />