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Cts <br /> Burnett County 7410 Co. Rd. K, N6. 102, Siren, Will 54872 Office of Zoning Administrator m m o a <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes ° <br /> g by application for a Permit for the work described and � rn � <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 0. <br /> regulations of the State of Wisconsin. - o <br /> N 41 <br /> N m <br /> �dO <br /> OWNER TELEPHONE f <br /> N-Sid J � ACer 6 -Ss ' o <br /> ADDRESS � So KA) I e S A e U�w i chm c V , W SyC i' 1 m <br /> 7"7S3 <br /> EMERGENCY/FIRE NUMBER .7 7 S ROAD NAME POu tit Ae �p 1 1 <br /> LEGAL DESCRIPTION (see tax receipt) PC/ /'. I .S{ �'� 3& 1 Iy r� i Tot -Fmeo<&,: <br /> CONTRACTOR <br /> C C.� l�7 !, /y <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> n L7 i--�— <br /> SANITARY PRIVY ( FILLING/GRADING /^ CAMPING UNIT SUBDIVISION o ° Q( <br /> STRUCTURE/ADDITION USE: N o ° <br /> (Home/Cabin'Commercial Business; Bedroom; Deck;etc.) Z o fti <br /> o a =� <br /> m <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). <br /> 3. Show dimensions in feet of the following:(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. 0 0 <br /> NOTE, BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. an a m <br /> PLOTP,,��AAnnyy Milt n <br /> Seeflltachec� r k ; s 7f' a n <br /> P2uh`n 18 W ° <br /> Srale�� N l ) <br /> m �n <br /> Seidel �fc• �r�dDw c.til <br /> iJ <br /> .Jew `rf <br /> I <br /> t k, �ch i_-5—I <br /> ...� e-G .e M <br /> �l€y J 1 o <br /> i o I e Nkye-I! a)SA but'* I d <br /> efF � srJe ofde,K, I N ' 1J <br /> 0 y <br /> N <br /> I4i <br /> LL) 4k,T I �r o o �' e / v .c Till e oc cl w ; cd 6 w .AA: <br /> z <br /> PC Pk AC e. / _F W. I[I q 54idt �'� GL. AS.1 Dvah, lThe <br /> (94d w ,&tjow Ati' Aa7 eck 4P C lQo i Pti .4.od <br /> l!eecq %v 6e Re7°� AC �z �, i hC ,Vets; d7eC k- ScfC, r'oV f <br /> IS col- .4CCes .s to Thr (7eCk frroM The Aiilh'vi <br /> R400111 m 0(nm Dao -0 <br /> g� , <br /> CONDITIONS OF PERMIT: m�. ,z c 8 g <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN ti0 DAYS OF PERMIT ISSUANCE. o F Lo E �1,� ' <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. O 2 m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy ofall informs- 3; <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- p <br /> mation I 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 N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. �' . m <br /> € 3 0 <br /> » ^ o <br /> SIGN HERE <br /> (signature of r or ildin c tractor) ate) <br /> Ni x <br /> 8 i <br /> ZONING ADMINISTRATOR t - <br /> N: <br /> TO NSHIP PERMITS MAY BE RECUIRED O N NT UW N NT O N m <br /> 000000001'A <br />