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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator CA��� <br /> APPLICATION FOR — LAND USE — PERMITS E <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makesthe <br /> located as shown herein. The undersigned agrees that all work shall be done in accordancenwfth the yrequiremeork rMs of the m c <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicaband <br /> le County Ordinances and the laws and �. <br /> regulations iN the State of Wisconsin. <br /> w m <br /> OWNER e�T J rr 1' �^ rot oZ"t/39-�0� c '? <br /> TELEPHONE �r5 �o S H2f Q n E <br /> ADDRESS I�7Dt� A -)T,1 STrU_wATt? P,4 S�o8a m <br /> EMERGENCY/FIRE NUMBER r'1-r SSLe <br /> CY f ROAD NAME <br /> H ' r 12�Rn <br /> LEGAL DESCRIPTION (see tax receipt) S 3(o`'rAI01 R 14 W LOT a <br /> CONTRACTOR <br /> Pct. 40,1 y .^ i'f <br /> SELF <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAOE/AooEegonv arnuc rURe_A_ ADDITION <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT <br /> SUBDIVISION- n o <br /> 0 <br /> STRUCTURE/ADDITION USE: [��� „F C t r Ay �»��� a r <br /> o ° <br /> Irtome/ abin Commerael Business;Bedroom;Deck;etc.) v <br /> z o <br /> 0 c <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 draiMleld (DF). r <br /> 3. Show dimensions infeetofthefollowing:(a)building to all lot lines,(b)buildingto center line of road,(c)building <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 <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. <br /> 3 <br /> PLOT PLAN L z <br /> "10 1 <br /> 31 m 1 <br /> C <br /> I%>sa'r E m n <br /> - <br /> ca T A ) <br /> yp y <br /> R <br /> (CIO LOT <br /> wter' <br /> 1 <br /> Liles r I f�6 <br /> Ir LfNG O Sax a�+ 3� <br /> o <br /> 1001 <br /> CONDITIONS OF PERMIT m�. CEAw lO <br /> L I = � mm � agm <br /> 1 e �L m. � � m a » � = n <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REOU EMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m a ? uzo fO =i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. o F i i -n rn ? M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 62 i p <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- g <br /> m � C <br /> 53 <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- a m <br /> tion contained in this application(including any accompanying schedule)and 1 further declare that I recognize that this infor- <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <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 <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> ryryT <br /> /\ ,p : A <br /> SIGN HERE 4R/- � E a d $ : <br /> ' <br /> N <br /> (si u of own building contractor) 11 ( -.] Ie) "� ' �^ ° u <br /> ZONING ADMINISTRATOR r <br /> $ t <br /> TOWNSHIP PERMITS MAY BE REQUIRED SEP 1 6 1992 H hp'� „ <br /> ))5n orn 'oo2Sm <br /> I---' ----_.._- <br /> $ $ $ $ $ $ $ $ m <br />