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611�1 CIA4' <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54072 Office of Zoning Administrator rn o 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS s <br /> oca <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � a (� <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirementof the V <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the la and _ <br /> 0 <br /> regulations of the State of Wisconsin. w m <br /> c g 0 <br /> OWNER I y[.E /�., SCvANSoA( TELEPHONE 6 /-Z- <br /> ADDRESS /2 <br /> ADDRESS 2r�R ! $UQu�2/3 [,{t Sr, l�A-Uc� M�rtl�-( ✓��� m <br /> EMERGENCY/FIRE NUMBER ROAD NAME ST/G L b aN <br /> LEGAL DESCRIPTION (see tax receipt) 5 (�—�7 514r3-71,Q l8 W , 41/0 Pat— 37 /QQ7eo2.7 <br /> CONTRACTOR <br /> +f7 ase Pr�F \ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE J ADDITION O f <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o a (`ti <br /> m r- <br /> STRUCTURE/ADDRION USE: o <br /> M <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o ii <br /> 0 <br /> m <br /> a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). <br /> 2. Show the location of the well (W),septic tank (ST),and drainfieid (DF). ° <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building O <br /> measurement to the ordinary high water mark of lake,stream,or river. l <br /> 4. H separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be all;ned and <br /> dated by the owner. Q <br /> NOTE: BUILDING/STFUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I 3 <br /> PLOT PLAN ST(t L 5 o r11 2�j c <br /> M i <br /> � O a <br /> IS r 1 I <br /> 631 <br /> �`a--fir'—� <br /> 4 <br /> u E oT a <br /> 519 �n18 J <br /> o <br /> coa �ay � ,S <br /> 55d <br /> ' � Z <br /> leo �' <br /> eoNcQt�lvN 6� �erm��- f7 5 <br /> W � <br /> / Pron sole <br /> ( C �� 9 <br /> R S 9.** '$j m <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. P <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. ' �' E ; ': In <br /> o i C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best o my knowl- 9: i X1 <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 °' m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize ih t this infor- O <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I g i <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providin 3 in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized Pot son to have <br /> access to the above described promises at any reasonable time for the purpose of Inspection. -n <br /> SIGN HERE <br /> (sign re ownsr or it ng contractor) <br /> R" <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED J'i j� I o ~G' b N. }S m <br /> - 88888 88 U) <br />