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Burri Court 7410 Co. Rd. K No. 102, Siren, WI 54872 Office of ZoningAdmin strator L'Or C� z <br /> County <br /> APPLICATION FOR — LAND USE — PERMITS s' <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work desci ibed and Q v <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requireme s of the m 1 <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. N <br /> OWNER �"qI_K I_K- �pOyf /R)u MIuCR TELEPHONE / 15 - 38�- 3133 a n <br /> ADDRESS l rl (ODO -III' ST- LA D '--1 iJ I S`+01(0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> 1' <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION I p <br /> n o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> 0 <br /> a � <br /> STRUCTURE/ADDITION USE: 0 4 <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z o e-� <br /> 0 0 VU <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) i <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate Norl It (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 O Q <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 sl,ined and <br /> dated by the owner. O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE LED. o rn <br /> c <br /> PLOT PLAN A o 0 <br /> M o <br /> C <br /> , <br /> N L <br /> Y� <br /> A7rA Nrp <br /> i <br /> 0 <br /> o <br /> O y <br /> TJ <br /> W <br /> Z <br /> f <br /> rs F.33 R. IF -e y <br /> CONDITIONS OF PERMIT: = R. <br /> Q CS NO i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c £� "z <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. fn': ' O m <br /> app (including Yaccompanying 1 Y y <br /> I declare that this application includin an schedule has been examined b me and to the best of m knowl- <br /> edge and belief It is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informa- m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor-mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue permit. I ; I i $r$ $ <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- i i ' <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized peraDn to have p <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> T <br /> e : <br /> SIGN HERE r I S « <br /> ( N <br /> (date) <br /> f Sf <br /> AY <br /> ZONING ADMINISTRATORIt <br /> `l <br /> NN NNNN+ Zr <br /> TOWNSHIP PERMITS MAY BE REQUIRE _ __.. o N N N N N S m <br /> 88�8888UP <br />