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PM <br /> UP I <br /> `b ' <br /> lumen County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m c c <br /> APPLICATION FOR — LAND USE — PERMITS f <br /> 'O THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work descriand a <br /> orated as shown herein. The undersigned agrees that all work shall be done in accordance with the requirement W the <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. m m IN <br /> C' <br /> OWNERTELEPHONE p £ <br /> Q-4 Ry S"dt_FIrZn j 9— �z9 0 <br /> ADDRESS '77 a i D R,a-,o t-r Y S?. r,Rt!�v, �1 3' Tom}g 9 2 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> Peet-- <br /> LEGAL <br /> e LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR V <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ CCESSORY STRUCTURE ADDITION p <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> o <_ <br /> STRUCTURE/ADDITION USE: ��j'� 2.Q o <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z � <br /> o ° <br /> c <br /> m <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). I 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. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sig ed and <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE UED. F2� <br /> 7I o N� <br /> c <br /> PLOT PLAN / o n� <br /> 1 m <br /> Co✓d, b� �eimr a � It <br /> ( /01 I)rnusf 30r-+ - ni � <br /> awn+l-otLl�e� YO_�Lf � lr` <br /> -t <br /> S" ion skit lob' L J <br /> N$�1 Al4 I <br /> 4-(II�� V i 4f <br /> - <br /> _ ° <br /> I <br /> I� <br /> o'I` `1 / / C? / <br /> c rr Are o lie 510 � <br /> Quos, G ,�`—ID f �Rdn.1 Cc�rr��e (� ►= .ST, <br /> Arvv R g4 'OHUM <br /> CONDITIONS OF PERMIT: o w' Z C� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. ? o$: ffi`Z 1 <br />