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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 'af o <br /> APPLICATION FOR — LAND USE — PERMITS . <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 requirements of the <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and _ <br /> regulations of the State of Wisconsin. - a <br /> w m <br /> n m io <br /> �r �: 1 J <br /> OWNER TELEPHONE � n O <br /> ' J I �(aIE <br /> A , a sr3 m <br /> ADDRESS k 3�9 7 /fWy O/� '7� �-fer���1 Uc Syq <br /> EMERGENCY/FIRE NUMBERa ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) PCI r i I e-` j / T3 gN ` It' , 1 <br /> CONTRACTOR (O '1 41 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADD p <br /> SANITARYPRIVY FILLING/GRADING CAMPING UNITSUBDIVISION <br /> b o` ^. <br /> STRUCTURE/ADDITION USE: o� O� r` <br /> w r <br /> Ora G g <br /> (Home ab' ;Commeroial usiness;Bedroom;Deck;etc.) yt-. /� Z o <br /> PJeGI. o a •-- <br /> m rs <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 dralydieid(DIF). c <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to Center line of road,(c)building -4 <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 X <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I v rn <br /> PLOT PLAN 71 o u <br /> mo <br /> b <br /> 30 mLj <br /> r d <br /> 1 P <br /> w fi <br /> J <br /> 0 <br /> v <br /> 96 �o <br /> a yfn � NrDD � <br /> m <br /> CONDITIONS OF PERMIT: ? A a <br /> t. ` 'ROo0 ,o' 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m'o : �� . 0 Zi <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ° F 3 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Yrn G) O <br /> B c f C <br /> 8 € m m <br /> I declare that this application(including any accompanying schedule)has po n examined by me and to the best of my knowl. S <br /> edge and belief n is true,correct and complete.I acknowledge that 1 am responsible for the tletail and accuracy of all informa. <br /> tion contained in this application(including any accompanying schedule)and I funder declare that I recognize that this infor- 8 m <br /> oration I accept <br /> providing will i relied upon s the County of Burnett Wisconsin in determining whether to issue a permit. I 8 m g <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. f 8 <br /> m ' � nxt <br /> w : w <br /> M $ <br /> SIGN HERE <br /> (si t e of ow r Wilding contractor) r-- 5 ), q p <br /> r� c , =------ <br /> ZONING ADMINISTRATOR t-- �" -- -- 11rNN`` ? 8 '. ? ? [ <br /> at i <br /> TOWNSHIP PERMITS MAY BE REQUIRE — 3 1992 �!11 g g o J o o <br /> _ '{ �9B98898888m <br />