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/ <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator u A a mcor 'z <br /> APPLICATION FOR — LAND USE — PERMITS '- 3. <br /> TO THE ZONING ADMINIST TOR:The undersigned hereby makes application for a Permit for the work described and Q y <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 3 e <br /> regulations of the State of Wisconsin. <br /> 0 <br /> N YI <br /> OWNER c `—° �O <br /> 2o3ee1 11102CHQ lSE TELEPHONE -JAS_ <br /> 71310 ; <br /> ADDRESS �1 � �- L�t�s-fc✓ c..� I _S`/�13 m i m <br /> EMERGENCY/FIRE NUMBER '� 2 ROAD NAME GT Y d v l <br /> LEGAL DESCRIPTION (see tax receipt) 40-T3 ,N PLf4T CF 2e,garE f+dd',A �J <br /> 543 Q4r o> NtFr Su I t.:!zE ly S 2fl To.; 051 4 <br /> CONTRACTORa �' <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAG ACCESSORY STRUCTURE_, ADDITION <br /> 0 <br /> SANITARY PRIVY FILLING/GRADINGCAMPING UNIT SUBDIVISION o o <br /> STRUCTURE/ADDITION USE: <br /> I X <br /> L B g <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) m <br /> Z a <br /> J <br /> m � <br /> DIRECTIONS FOR PLOT PLAIN DRAWING: (Aerial or top view) - <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indlcate North(N). <br /> 2. Show the location of thew well (W),septic tank (ST), and drainfield (DF). r <br /> 3. Show dimensions in feet oft efollowing:(a) buildingto 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. <br /> NOTE: BUILDING/STRUCTURE L 0 ° <br /> TIONS MUST BE STAKED FOR ONSrrE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. an c <br /> PLOT PLAN In Z <br /> AP a <br /> t� y <br /> � O <br /> i <br /> � I� - <br /> D <br /> N <br /> 01 <br /> } <br /> N 7 � <br /> 0 <br /> r� <br /> J <br /> w d <br /> 3 <br /> r 0a <br /> CONDITIONS OF PERMIT `^ —�'� n m 4 m m <br /> I. DRIVEWAY MUST MEET DRI EWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c m L. L 8 >> -E <br /> 2. REMOVAL OR CUTTING OF REES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ° f ' �rn � —1 <br /> 3. NO GRADING OR SHORELA D ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. to <br /> 4i ' L7 n m <br /> �E m _IFC <br /> I declare that this application(incl ding any accompanying schedule)has been examined by me and to the best of my knowl- 4 <br /> edge and belief it is true,correct a d complete.I acknowledge that I am responsible for the detail and accuracy of all informa- ��/�!` y.w u <br /> tion contained in this application(ncluding any accompanying schedule)and I further declare that I recognize that this Infer- �: $ B g : m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin rt determining whether to issue a permit. Im <br /> further accept all liability which m y be a result of the County of Burnett relying on this information I am providing ` o 0 :; <br /> D g in this ap- <br /> access t 1 agree to permit county officials charged with administering county ordinances or other authorized person to have n�i i <br /> access to the above described pr mixes at any reasonable time for the ur ose of ins O,^ 0: <br /> purpose inspection. D o m <br /> A n eA0 <br /> SIGN HERE �-.,4..+R t V.�,--x-n.--.` _ .29 <br /> (Si lure of ow or building Contractor) „++�I (date) <br /> ZONING ADMINISTRATOR <br /> ` HZ [ <br /> (nw(nuw V T <br /> TOWNSHIP RMITS MAY BE REQUIRED <br /> o � � N N N m <br /> 00000� O m <br /> Ott) <br />