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0/1 mlw <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> m 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 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 County Ordinances and the laws and <br /> regulations of the State of Wisconsin. s uprl W 1 <br /> Sl �' O <br /> OWNER 'M^ /`G J C,h 1 �LL TELEPHONE a <br /> �Jv I J_--CS t, (7 15 4 9 <br /> ADDRESS 3CI A6 l A rn P <br /> EMERGENCY/FIRE NUMBER L ROAD NAME <br /> n C A T <br /> LEGAL DESCRIPTION (seetexreceipQ AI � I I 1 5�y ' T3K'^' '-R��w <br /> r J <br /> CONTRACTOR &. 15 <br /> y^v <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION p <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION o o <br /> STRUCTURE/ADDITION USE. r <br /> o 0 <br /> (Home/Cabin;Commercial Business; Bedroom; beck,etc.) R 0 o m <br /> 0 <br /> 9 <br /> N <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). <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 9 <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. in 3 ur <br /> PLOT PLAN e ' J <br /> , Qrev , CorreI'�O elf I _XAV" < <br /> s SOop' o n 'a <br /> w s beep A.I,Q � g �eut area' m <br /> 1- <br /> $ — — N �SSue r � 1< f, 17 / Ir16 1A. 5oro C , <br /> a <br /> P _ . .�._, 1111 J <br /> �'t Q0n <br /> �1t 0 <br /> T — o <br /> E 13 30 z <br /> m <br /> w I � <br /> Z ( <br /> V--S2 = I� <br /> I z <br /> 30 <br /> cm <br /> F <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m o rD <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P F ur d' 9 <br /> N[ G72 '�[ m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o ; n = rn <br /> I declare that this application(including any accompanying schedule) 0 has been examined by me and to the best of my knowl- o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- h m w m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- ,`a 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 i $`$.g <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- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have Oro m <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> 1e m <br /> SIGN HERE l- ,(;c-,G____. 05_1.3 _ <br /> r, x �- <br /> ( Ifnalare of owner builAing contractor) (ddtepl`,' o �E <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED '^ MAY 13 1994 c N a w m <br /> og g20 (A <br /> 0 <br />