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N a-yy, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator o a o <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 2 w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable Goumy Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. H <br /> OWNER TELEPHONE c £ <br /> P G 4/3 Z <br /> ADDRESS 93Eo <br /> �_(' aj7 � La�-' <br /> t-�-^1 f movs)o� <br /> EMERGENCY/FIRE NUMBER �QI(_^ ROAD NAME.�� <br /> Inh 1 1� ��. n <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—L GARAGE/ACCESSORY STRUCTURE ADDITION <br /> ct <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a <br /> STRUCTURE/ADDITION USE: #D1>,' LDN f/y/h/� /Y Yl7 � �n L}!2/}(o L; = 5�27[�" 0 0 <br /> (Home/Cabin;Commercial Business; BS room; Deck;etc.) Z <br /> 0 0 <br /> 0 <br /> m <br /> 3 <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 (W),septic tank (ST), and drainfield (DF). o <br /> 3. Show dimensions In feet of thefollowing:(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. C <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. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 v rn <br /> an C <br /> PLOT PLAN o a <br /> //t� C ) <br /> (� Acre �dree L ' \ M <br />� i Ivo <br /> 4� o <br /> I / PROP <br /> JerlhPiAJ ij,[it,E �Y�uaRn6E s <br /> 0 <br /> NB' "'O ZOb r02. <br /> T <br /> n� o <br /> f32d 40 <br /> �Xtstfub �� � <br /> LJWCL L II095nT, F4'y,«I'• PRov'_Am <br /> W9Viad�' � f <br /> R a <br /> m i€� 2a a m <br /> 77_.. e. m <br /> CONDITION OF PERMIT; c S.: •z ; <br /> 1. DRIVEWA MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAY PERMIT ISSUANCE. o 0 o : r I I 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. /� � itr; <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. CU.. St: I O2 N:` m <br /> g E a C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- : a : : m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs. m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I `$ <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, y, <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to iN <br /> access to the above described premises at any reasonable lips f the purpose of inspection. r E 3 0 <br /> A : <br /> SIGN HERE <br /> (sililiate of own bd g co tractoq <br /> ZONING ADMINISTRATOR 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED «"jtl"P1P1° T <br /> i 14 94 04N� UNi �0 � m <br /> L 0 0 0 a 0 1 1 N <br /> an <br /> 0 <br />