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c: , <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator rn 'a -+ z <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> p o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � H <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. n rvnl <br /> regulations of the State of Wisconsin. N o <br /> OWNERa � <br /> Ro t f VAdim fMr"C R L ANP TELEPHONE 715. L3 5% 74 SIO m � <br /> ADDRESS ! <br /> HCR 94, .Z 78(e(o r'l daNfY /ec ADa�/p OON¢R� w �y&O/ � ` <br /> EMERGENCY/FIRE NUMBER E Llo ROAD NAME MOO NE-y R0A D g..� <br /> c 1c n ( m <br /> LEGAL DESCRIPTION (see tax receipt) / -_-Y � ACM ��� � 07 �J Jam- o� Thu � /C��/w _ <br /> CONTRACTOR I L.-!1/ L,J% 7 4- <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ I ADDITION p <br /> n L7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION � <br /> STRUCTURE/ADDITION USE: GARAGE 4 1ToRA6C 844IL01,46 'X 3z' <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> o <br /> D <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) / CA <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). ` F <br /> 2. Show the location of the well (W), septic tank (ST), and drainfield (DIF). <br /> 3. Show dimensions infest ofthefollowing:(a)building to all lot lines,(b)buildingto center line of road,(c)building O 01 <br /> measurement to the ordinary high water mark of lake,stream,or river. P <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 0 <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 a m <br /> PLOT PLAN o a <br /> A ' <br /> in o <br /> I(o0.3' C C� ' <br /> _ e) <br /> u m 1 <br /> � 4-- <br /> 30, <br /> v 3 <br /> ND y < V r <br /> xa• y t n <br /> � G — <br /> 3�' W <br /> �J 3 <br /> o ° <br /> C __. <br /> 3 m <br /> F ? = �. <br /> M G <br /> 0 5t Z <br /> x f <br /> m \ <br /> 3 <br /> M g)c-OLD, -0 <br /> D <br /> 2. Q O M <br /> CONDITIONS O P MIT a y. CS <br /> 1. DRIVEWAY MUT DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o m o' -1 <br /> 2. REMOVAL OR C I G OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. F 2 it N <br /> 3, NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N �- m <br /> o : 3 D <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o: i C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- rn m<: m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 60�8 O <br /> o : <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 ; O o <br /> access to the above described pre"es es at any reasonable time for the purpose of inspection. m c 0 - <br /> m v �o <br /> SIGN HERE ���✓�� ` g $ <br /> (si at a of ow building contractor) (date) 1 i <br /> . 8 <br /> ZONING ADMINISTRATORor <br /> [ $ <br /> (n u+a«uH <br /> TOWNSHI PERMITS MAY BE REQUIRED °o N N N N m <br /> \0000 o N <br />