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Burnett County 7410 Co. Rd. K, No. 102, Siren, Will 54872 Office of Zoning Administrator .0 ��o- 0
<br /> APPLICATION FOR — LAND USE — PERMITS 0 3 0
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<br /> TO THE 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 m m
<br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3, 0 1
<br /> regulations of the State of Wisconsin. m m
<br /> 612 2- o-/12 / 6j °
<br /> OWNER © ' �L (�6,�C TELEPHONE �1�21_— -7/ —Qo 36
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<br /> ADDRESS W/_5-g'O egX?- A1- Ave- /ULff `it'/dyCY
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<br /> EMERGENCY/FIRE NUMBER ROAD NAME PErrRSaN
<br /> LEGAL DESCRIPTION/(see tax receipt)) ) '
<br /> eSM Y.i Pf,9 e,L Y( 5.11/I/A(�,1-S& S^2(7'7-3 7R iZW
<br /> CONTRACTOR / L Ill
<br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O
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<br /> SANITARY PRIVY FILLING/GRADING CAAMPIIN�G UNIT—X—
<br /> SUBDIVISION �
<br /> STRUCTURE/ADDITION USE: � � / r I(�'Li1 Oc _ ° 'l
<br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Iz
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<br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) t(
<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). g
<br /> 3. Show dimensions in feet of the 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. _
<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. C o
<br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '1I 3 to
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<br /> PLOT PLAN ° a
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<br /> r0 OUR C'r4,'�/,vskJG A-S N/s H0.+4e- /'s' "= %.All )aXam le,--,f ' �F �
<br /> OUR �i�o/�r7ErY, o rJ
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<br /> LIKE Na,<'&/ES Cc UN/ rs oSH"L'A) O/L �4 rr�CHCD e�trrZvo
<br /> PRo.�ast ro L0C�tTc /Af &47'v me se+tortJ /4Rc�9 us- As Dune rR,vr',
<br /> PUS+/PES' rX'VCK Co u� ,l� �E,pio.l�sCifcC )` F�ti7P:y its iflc�Dc�f�.
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<br /> CONDITIONS OF PERMIT: ^ < _'= CS 0 rc i
<br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o £ it
<br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =
<br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. � bo' ig OE = p
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<br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my know)- 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. m
<br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor-
<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 a
<br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have m o
<br /> access to the above de ribed premises at any reasonable time for the purpose of inspection. m -oo
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<br /> 7 ars z.f t zJ 3 -1
<br /> SIGN HERE a
<br /> (sig to a of owns building contractor) (date) t�, ` `
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<br /> ZONING ADMINISTRATOR
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<br /> TOWNSHIP PE ITS MAY BE REQUIRED o �N m
<br /> 0000 o0ou)
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