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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54672 Office of Zoning Administrator rA -a 1 z <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> 3 � <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 snail be done in accordance with the require rns of the u <br /> Burnett Count'Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and th laws and <br /> regulations of the State of Wisconsin. ) <br /> m m <br /> OWNER K P� II i h Ya1^G TELEPHONE 6 1Z) T r _ 7 b n 0 O <br /> 11 / r^ 01) £ <br /> ADDRESS 6 Z D L G1 i o o d St, Poµ' wN "1V p , <br /> C 1 <br /> EMERGENCY/FIRE NUMBER N �" ROAD NAME Be AC 1. JT, J ` <br /> L i <br /> LEGAL DESCRIPTION (see tax receipt) OTS 2- 4~Z bloc IC 3 L4 Ke V I eW <br /> CONTRACTOR IVAI <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDRION t7 <br /> SANITARY _ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> o < <br /> STRUCTURE/ADDITION USE: L-A ei o 0 <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z <br /> 0 0 <br /> a <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 No h (N). <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). o <br /> 3. Show dimensions in feet ofthe 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 Wined and M t I <br /> dated by the owner. O 0 lJ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE SSUED. 3 <br /> O rU c <br /> PLOT PLAN PLAN �--- rf70 —� SEE VARIANCE #529 o a <br /> t --' C � <br /> `0 i arm <br /> y <br /> \ ! C r o <br /> 1 SO I m <br /> qy� I O <br /> +0 n <br /> I I <br /> e �� g <br /> 0 <br /> CONDITIONS OF PERMIT: v <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. = m 1' zi i �•2 5 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ° £ 1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. rn C) m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of al informs- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that his infor. t7 <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing i i this ap- <br /> plication.1 agree to permit county fie charged with administering county ordinances or other authorized person to have t7 <br /> access to the d cribed A 1 nable time for the purpose of inspection. <br /> m i f <br /> m <br /> M <br /> SIGN HERE4L <br /> Ig u to <br /> wrier or building eontraetoh <br /> _ _ (date) _ <br /> ZONING ADMINISTRATOR <br /> U4 f gE <br /> TOWNSHIP PERMITS MAY BE REOUIRED ' f 1 9 0 � <br /> N N m <br />