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lco <br /> 111P' <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator W m fc <br /> APPLICATION FOR - LAND USE - PERMITS m . <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q w ° <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirerr ems of the m <br /> Burnett Courcy Lard Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. w m <br /> OWNER M�,rK Hare R��e� TELEPHONE S- 4-7`-D h v,,_ a )1 O <br /> 1 <br /> ADDRESS i6q�j, j �tVI XV(f L W S� 8? 7 <br /> EMERGENCY/FIRE NUMBER ROAD NAME cr�x4a <br /> i <br /> 90/ T LL ro <br /> LEGAL DESCRIPTION (see tax receipt) L0 f�-- N1 V ICL P r7 r '- <br /> � �CONTRACTOR � <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE X ADDITION p <br /> n 0 <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION o o C� <br /> STRUCTURE/ADDITION USE: <br /> 0 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> 2 Q <br /> O O <br /> A <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 (ST),and drainfieid (DF). <br /> 0 <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,( )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 I Igned and 0 <br /> dated by the owner. 5}H K{<< c1ee �- lolact M a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSfTE VERIFICATION BEFORE A PERMIT CAN B ISSUED. <br /> PLOT PLAN I Z <br /> S <br /> y 0 <br /> = <br /> P li <br /> dpcK � � <br /> �F-- 8D <br /> o` <br /> _ <br /> itJ N k <br /> O <br /> _ <br /> 0 � <br /> w <br /> I <br /> Ci <br /> Z <br /> L�Ke_ \ <br /> e r a� g <br /> CONDITIONS OF PERMIT: v K. c g M <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN e0 DAYS OF PERMIT ISSUANCE. e f i �`� : 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. N; M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 'LJ ut i '. �, ' m <br /> _ $ Er <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 all informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- �IIE i B In <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issu4 a permit. <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 premises at any reasonable time for the purpose of inspection. <br /> M <br /> SIGN MERE ' a <br /> (s net re of owner o Iding contractor) (date) Q1 <br /> 7€ <br /> ZONING ADMINISTRATOR �"� E $ <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> m <br /> oN�B d <br /> 88 $ $ 8 8In <br />