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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and z m <br /> located es shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <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. H m <br /> 1U'It7--� 1� /f /' n O <br /> OWNER 6 !l crU TELEPHONE <br /> r0. J/ <br /> ADDRESS & r r� /� J_ m t <br /> EMERGENCY/FIRE NUMBER ROAD NAM /�er�E{ /�G. /t° S L 1Jh l^7 <br /> ( P) Elri LUCdI' g 4G7rJ��hf7LQ <br /> LEGAL DESCRIPTION see tax recei t r� �" e <br /> IJlH4 )4 o5L %S� �frC /3 TJ'fu R�/sd4r t Le C <br /> CONTRACTOR <br /> ` /p�1�_. <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ CCESSORY STRUCT RE J� ADDITION p <br /> SANITARY PRIVYFILLINGlGRADING CAMPING UNIT SUBDIVISION o <br /> o <br /> J �y <br /> STRUCTURE/ADDITION USE: <br /> (Horn / abin; ommercial Business;Bedroom;Deck;etc.) <br /> Z i <br /> o � <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 drainfield (DF). I 5 <br /> 3. Show dimensions in feet ofthefollowing:(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 signed and <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 3 rn <br /> c <br /> PLOT PLAN n o 'n <br /> M <br /> o <br /> 'J C I J <br /> 1 <br /> I <br /> 0 <br /> J <br /> N <br /> C-IeA� - <br /> U"'l iaw <br /> �vrar*4 DL-A)Ners' <br /> o c o m D T <br /> Q p J <br /> CONDITIONS OF PERMIT: ? < C 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o f ? - J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ M <br /> m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. I m n O <br /> gE ci <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowk o 5-3 <br /> edge and belief it is true,correct and complete.I acknowledge that lam responsible for the detail and accuracy of all informs. <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I m <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing in this ap- w <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 premise ny reasonable time for the purpose of inspection. 3 x <br /> T <br /> m m > m <br /> _ m8 <br /> SIGN HERE d, . <br /> ign of ner or bui contractor) ���_ '( �tE) L : z <br /> ZONING ADMINISTRATOR <br /> JUL - 719W <br /> II I 6)N fA888 m <br /> TOWNSHIP PERMITS MAY BE REQUIRED !` N o "no . . m <br /> 8 8 ren <br />