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(9 I V&xpi <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator In m o 0 <br /> IE <br /> APPLICATION FOR — LAND USE — PERMITS 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 shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. rn m <br /> w <br /> �y� c <br /> OWNER [G�L�S.(� / //C C/j��Q;j� � E TELEPHONE �I S S 7 Q O 0 <br /> ADDRESS - 1 Z aI /ZA /A.JE `ZD 4S5 She71 ,Cd �,f)' M4 551a I <br /> EMERGENCY/FIRE NUMBER 1 8 r ROAD NAME )2PC1 AJC- <br /> LEGAL <br /> JC <br /> Alax� m e �Z 1� V7q G1� $u(3 r y rsP 0 <br /> LEGAL DESCRIPTION (see tax receipt) Lo 7- 4 2 �3 LX 3 L 40 jLj 1,$� 01300 <br /> CONTRACTOR SLFL�' <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n L) <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> f ei r <br /> STRUCTURE/ADDITION USE: R A <br /> (Home/Cabin;Commercial Business;Bedroom:Deck;etc.) Z o <br /> o � <br /> DIRECTIONS FOR PLOT PLA 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 thew II (W), septic tank (ST), and drainfield (DF). 3 <br /> 3. Show dimensions infest oft efollowing:(a)building to all lot lines,(b)buildingto center line of road,(c)building <br /> measurement to the ordinar V 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 <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE L TIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I 3 m <br /> PLOT PLAN Z <br /> Ifillo a�l <br /> DO < <br /> Tc "°,te <br /> w <br /> 12AC'14)e fA �' <br /> _- <br /> � d <br /> s I <br /> i )Its 0 <br /> u3 _N <br /> 2Z/ 1u lb <br /> GA2A6 <br /> H bNsc 149 <br /> g <br /> ES �' 8 <br /> (� QD <br /> �/ Z <br /> AD <br /> c w r 10 m <br /> >a <br /> CONDITIONS OF PERMIT: ui < m'= `Z CS M m <br /> 1. DRIVEWAY MUST MEET D IVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o <br /> 2. REMOVAL OR CUTTING C F TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N M <br /> M <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. !^ O 2 <br /> C ado : <br /> I declare that this application(i cluding any accompanying schedule)has been examined by me and to the best of my knowl- o C <br /> edge and belief it is true,corre t and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- «+m- m <br /> tion contained in this applicati n(including any accompanying schedule)and I further declare that I recognize that this infor- B p <br /> motion I am providing will be lied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 g <br /> further accept all liability whict 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 coui ity officials charged with administering county ordinances or other authorized person to have iO N p <br /> access to the above described premises at any reasonable time for the purpose of inspection. i 3 i, <br /> m A N <br /> I ` I? ��.7 N N <br /> SIGN HERE � '-�-t�3� ..�.. <br /> (siu of owner o 'Iding contractor) <br /> o ; <br /> ZONING ADMINISTRATOR ` g ' K <br /> TOWNSHIP PERMITS MAY BE REQUIRED I' o N a 0 m <br /> — 000 o N <br /> 0 <br />