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c'zyrP, <br /> Burnett Countw 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m 'o � z <br /> m e o 0 <br /> APPLICATION FOR — LAND USE — PERMITS _. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m c <br /> Burnett County Lard Use Ordinance,Sanitation Code, and with all other applicable Country Ordinances and the I ws and <br /> regulations of the State of Wisconsin. &13 — <br /> ) 3 ,3 o <br /> f g <br /> OWNER � D (9I2 9,2q —OO g O <br /> TELEPHONE <br /> /y� m m <br /> ADDRESS 4 3 2C7 PFiO b 0't1' e SU I I 1 1►1 A t-' - I 1 5 41/j <br /> EMERGENCY/FIRE NUMBER Atari a ROAD NAME p. t to LZL K.., <br /> LEGAL DESCRIPTION (seetaxreceipt)GOUT LOT 5Fcl7DA) <br /> CONTRACTOR C f"C:, S e r-t O N e.(Z 715-- & 3E <br /> - 37 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> SANITARY PRIVY—X— FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> o < <br /> 77 m r <br /> STRUCTURE/ADDITION USE: g g <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) T <br /> Z o <br /> 0 c <br /> m <br /> a <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 drainfleld (DF). o <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c) ullding <br /> measurement to the ordinary high water mark of lake,stream, or river. <br /> 4. H separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sig ed and 9 <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE UED. 7I a q <br /> PLOT PLAN <br /> 'I fJ z `o <br /> (� <br /> 4l'�(S- <br /> C <br /> -)jI o <br /> a <br /> ii,too L'LV <br /> cn <br /> m <br /> 1 <br /> L <br /> f4 •` CrIl mac;•� � `� � <br /> 0 <br /> \S0 Nth G' 1 f <br /> In <br /> `0.151 s e -k�dr�f +a pct <br /> IJeI�J 1id` g tFL, <br /> Skef�YL , __�< �� aim <br /> CONDITIONS OF PERMIT: ------- 0 <br /> w <br /> C8 =0 m <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 5i S.R <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 9 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. !^ : O In <br /> In <br /> g ' E : C <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of try knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- «.ro H ' 33 <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- N3 p <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. $`� $ <br /> further accept all liability which may be a result of the County of Burnett re y{--oRtYi44nfWmaUon tam-providMg in this ap- ' <br /> plicatlon.1 agree to permit county officials charged with administering couoty ordinances or other authorized person to have O; p <br /> access to the above scribed premises at any reasonable time for the purpose,of inspection. : m <br /> SIGN HERE <br /> APR21 <br /> (sign to towns Idinp contractor) (date) <br /> ZONING ADMINISTRATOR <br /> S�t Kc- � TOWNSHIP PERMITS MAY BE REQUIRED o Nfitm8tE $ tom <br />