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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 5 �j; ' z <br /> APPLICATION FOR — LAND USE — PERMITS10 <br /> 0 <br /> TO-THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 9 m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the o 02 <br /> Burnett County Land Use Ordinance,Sanitation Cale, and with all other applicable County Ordinances and the laws and �. $ <br /> regulations of the State of Wisconsin. ` m <br /> OWNER 21 C+A D )FF,1n1 `,LAN SkJ <br /> � TELEPHONE (���' 1 QS Z J (j e E <br /> J <br /> ADDRESS 23 7 p I T`{ F W (S 4 A TS Pt4 aC LAJt j4$4a u <br /> n ) <br /> EMERGENCY/FIRE NUMBER z J 2 Z Q' ROAD NAME <br /> ll �1 <br /> /Vk N x 5E C 2 S Tw -53 I $ -J 40 c,Et%' S' <br /> LEGAL DESCRIPTION (see tax receipt) S��L S f: C 5C Z y Twig. 38 IT w Zcu 14c a:c <br /> CONTRACTOR WICK L�Cr Nlutsrn�l`'rZ,) 11triYSE (c 17i2aw.�fn.o )FN-'brP-)6�GUje4gHSa n9Sr" ' <br /> TYPE OF PERMIT(S): DWELLING/BUILDING— GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> � � <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> o` <br /> l O <br /> STRUCTUREIADDITION USE —,.#,t: <br /> ome/Cabin;Commercial Business;Bedroom; Deck;etc.) Z v <br /> o ° <br /> 0 <br /> m <br /> 3 <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 (N),septic tank (ST),and drainfield (DF). I o <br /> 3. Show dimensions In feet of the following:(a)bullding 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. ON o N <br /> PLOT PLAN o Z c I <br /> c <br /> S�-: t 4N\CA- O-A �1\CLA <br /> V, s 1 <br /> 0o9b 0) <br /> m <br /> II`v o w <br /> Z <br /> t D <br /> 6= � <br /> EL Inz <br /> CONDITIONS OF PERMIT: = z• Z c$ g r M <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN GO DAYS OF PERMIT ISSUANCE. 0 4 Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. , �gN m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. a k P <br /> Fr o <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. i <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- ; p <br /> motion 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 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 hove <br /> access to the above described premises at any reasonable time for the purpose of Inspection. <br /> mTm <br /> AILti <br /> SIGN MERE E ..S <br /> (sig aturo of owner,r bullding contractor) aN) <br /> ZONING ADMINISTRATOR C'-A <br /> ��� $ <br /> TOWNSHIP PERMITS MAY BE REQUIRED �o v,, bi . <br /> !8888811.0 8 <br />