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nett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U m O a <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> TO THE'ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m c <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 <br /> regulations of the State of Wisconsin. �, m <br /> w � <br /> / m (7) O <br /> OWNER pgT/efciH SO LIMO )Son TELEPHONE (7/S) 6g ri -� 1�3 <br /> ADDRESS 23170 /9UnttRr>7 kHKe Ra `Act <br /> EMERGENCY/FIRE NUMBER o2 3 1 —7 Q ROAD NAME Du n h t9 m L 049 Ke- R, lS1 <br /> LEGAL DESCRIPTION (see tax receipt) S 2 '9 T 3$ R 1 7 Lor 3 C5M V 1 P eSS' <br /> CONTRACTOR �j/81/ livilifE Lfq KE 61n 6OVT TINS <br /> TYPE OF PERMIT(S). DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o U <br /> STRUCTURE/ADDITION USE: 5cecn POctrih £ Open "pf--C_h o ° O <br /> (Home/Cabin;Commercial Iffusiness; Bedroom;Deck;etc.) Z o J <br /> 0 v <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 (DIF). I 0 <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 W <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a y <br /> PLOT PLAN [� n o n <br /> See 4�7ac 114 m aa- <br /> to SLJ <br /> 0 <br /> N <br /> w <br /> I <br /> z <br /> S <br /> 1 <br /> 0 c: M. 0) r ➢ DO M <br /> CONDITIONS OF PERMIT: <br /> o N. C o 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 'z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. i» N m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �' � o I <br /> C <br /> gn I <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- S o m m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs p w 0 N O <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 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 8 8 <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- N <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have , Q u, p <br /> access to the ab o ascribed premises at y reasonable time for the purpose of inspection. <br /> 03 01 A 4 <br /> ^ . <br /> N rn 8 <br /> SIGN HERE <br /> (signature of owner or building ct (date n <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PER S MAY BE REQUIRED <br /> NNNFF IJ1000 m <br /> ggg �ggggy <br />