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.92_cn>' i <br /> Burnott.CouMy 7410 Co. Rd.K,No.102,Siren,WI 54872 Office of Zoning Administrator m x o 0 <br /> m <br /> APPLICATION FOR - LAND USE - PERMITS ' <br /> o <br /> TO THE ZONING ADMINISTRATOR,The undersigned hereby makes application for a Permit for the work described and b a <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 6 c W <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 <br /> c <br /> • 0 <br /> OWNER 1,0? (iiic A r/s O.Li TELEPHONE af <br /> o • <br /> ADDRESS RyoX 6/S Sfcf.0IX pjy//S �,,--- yO.. / 0 <br /> t:::),. <br /> EMERGENCY/FIRE NUMBER ROAD NAME //---Az,it) 1.4.• 0r\ NSI <br /> LEGAL DESCRIPTION (see tax receipt)La� . c.5.„..,, .3..-,3y.„.2 5/3_r40,L, r1 ��� vSu/4• <br /> ""_' <br /> CONTRACTOR t•-) ' D <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION /X\ p <br /> ITN n O 7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> STRUCTURE/ADDITION USE: --.57/}/1),! Z Ad t e , o g <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) z v <br /> ° .2 <br /> ° <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(Si),and drainfield(DF). 9. <br /> 3.Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building 1 <br /> measurement to the ordinary high water mark of lake,stream,or river. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE SSUED. II v v, <br /> PLOT PLAN 3 o a <br /> C l°1 <br /> 5 _- ` �/ /,,C /ter/ Ir!{ n <br /> kr5 5 w (t11 �' <br /> kr•A°v.v,.....0„, (.,.--ActAANP----, _. , Dr ,..„ <br /> , c. <br /> ,.. , <br /> 1.6`17,:-.:„)\ t <br /> s <br /> �a� 2 w <br /> 00S <br /> L <br /> ^ ` 7 N <br /> 1A z <br /> VPi <br /> / hi' <br /> F <br /> CONDITIONS OF PERMIT: ..F •1. . I� g43 .1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. v' xi <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 11 m <br /> 8 g <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowl- Q . IS3 <br /> edge and ballet It is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize that this infor• p <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit.I 8 or <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 <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> ,p5/// <br /> a M <br /> �f1 o>/< /l y' S�i o/ a u <br /> SIGN MERE 5/ 9k <br /> 4. <br /> (signature oflorjui contractor) 5/4-/q <br /> /Idatee)) 25ZONING ADMINISTRATOR ./. ✓�F y T g <br /> M w Mw N <br /> T W#ISHIP PERMITS MAY BE REQUIRED 11!1 t5 ti~N g'Si g A <br /> 88888888 Vol <br />