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cot M/q-), <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m o' 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> Y C <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requireme s of the $ (� <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 /> w m <br /> c <br /> OWNER � Cod bQ a N TELEPHONE _ m E <br /> .e a 0 �9-93D5 m <br /> nn 11 pw m , <br /> ADDRESS f gc(te Tk, w 36a 1 <br /> 1 <br /> EMERGENCY/FIRE NUMBER O 0 $ G10 v tw Kr� ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR Ke 1 S 'btw.AIv : o%G yYo 1 6 y o F r✓ L)0'-'f;"t2l 41. SY 3 a <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVYFILLINGlGRADING CAMPING UNIT SUBDIVISION 0 <br /> o <br /> (n�I 1 J <br /> Se 6rf� g'U 8vtz f +� 0 o <br /> STRUCTURE/ADDITION USE: n 1n.1 � s Cto M � <br /> (Home/Cabin;Commercial Business;Bedroom; eck;etc.) Z <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 North (N). <br /> 2. Show the location of the well (VV),septic tank (ST),and dreinfield (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 sIG ned and <br /> dated by the owner. <br /> 00 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED, 09 vMill <br /> y <br /> PLOT PLAN o 'o <br /> C . e S' pbm� khto r <br /> I o i,aor^� +a <br /> C ( ' <br /> s0�N Sa <br /> LK <br /> I o <br /> � u 0 <br /> 3'1P�jo — <br /> IS <br /> M Kk <br /> < J/ <br /> BWl+,e 4Naf"e...3ro� Pse 'T14 m <br /> 3�� <br /> w <br /> t 77b z <br /> D <br /> 0 <br /> GkK� �c a <br /> alaf(dfre f <br /> I 7a <br /> CONDITIONS OF PERMIT: m g ,z c� g� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F i [ -Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED.' O m <br /> C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of y knowl. Oi <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of a I informs• wa «� m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 15B p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue permit. 1 t ; 91 $ <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 p <br /> access to the above described premi s at any reasonable time for the purpose of inspection. <br /> i $ a <br /> SIGN HERE ` <br /> a? <br /> (signature bf owner or building contractor) I , "—— (gate) <br /> ZONING ADMINISTRATOR try, $ <br /> I . <br /> TOWNSHIP PERMITS MAY BE REQUIRED MMMMNN«6f m <br /> � _. - � �8S5� � IX15 m <br /> l '`� 88888888 ai <br />