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bi (tom <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m c o <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m o — <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m c -Z <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. <br /> yy�� w <br /> OWNER `�ICAARO�{T6R{�GERUD TELEPHONE ZSq • •''q C)�, a E <br /> ADDRESS _ I O I ICC,1"t S U ' TS — TR - Tl� 1N ILS ( M <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) y v <br /> I <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> CC � o <br /> STRUCTURE/ADDITION USE — �2y� <br /> (Home/Cabin;Commercial Business; Bedroom; D ck;etc.) Z <br /> 0 0 <br /> v <br /> DIRECTIONS FOR PLOT PLAN DRAWING; (Aerial or top view) I� " <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 -8 <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 A <br /> dated by the owner. <br /> Go <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrrE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on 3 <br /> c <br /> PLOT PLAN o n <br /> M <br /> 0 <br /> C <br /> M <br /> i <br /> hS a� <br /> Pert-,+ <br /> 1, 00 OU m� BPXk- pr '0r``�'1 j LVIL11rw SG�rt c' � l <br /> 0 <br /> be, over 10,UW t�� e kCG«� � /}1e�1 • e (T <br /> o » <br /> n1 � n <br /> �Q Dr d o w tv- -t'� CAjv b2 rreroul?ep z <br /> Sail oN l tti� std 6G Uhn(U -f3 6(_ t7 l=ay <br /> _ <br /> S_t" w S"S _1b b� AI" QA- ons W-P- Sic <br /> m <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F TQ a <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 1lJ ro <br /> 8 a <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- CX1 <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- ,� N <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I g m 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 N <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. :y 8 $ <br /> r M A <br /> SIGN HERE_ r��. <br /> (signature of owner or buildin ontracton �I ' I —(dafaj" <br /> r <br /> ZONING ADMINISTRATOR i E ' <br /> i i i i i <br /> TOWNSHIP PERMITS MAY BE REQUIRE U <br /> pp <br /> tplpO pO <br /> i O O O O O O <br /> 1 <br />