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C160' " y <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m f o <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 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m —F— <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and n <br /> regulations of the State of Wisconsin. m <br /> N A <br /> n <br /> OWNER I n0 r TELEPHONE g �— o f <br /> ADDRESS 26aaq- 1 d I � <br /> CC ill ll..V/l�lll j VVV�w���JJJ Y v-Y l 7 O I- •XI J -J.�v.J <br /> EMERGENCY/FIRE NUMBER <br /> �r.AcIyt ,>oR.OAD NAME <br /> LEGAL DESCRIPTION (seetax receipt) <br /> COMC A D(/d 1 <br /> �eCer <br /> kap S�k4 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION _ o <br /> n L1 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONa ° <br /> STRUCTURE/ADDITION USE: C q NG e 2 Q ems" I y0CN"U'l Ll O-n ° (, <br /> (Home/ in;Commercial Business;Bedroom; Deck;etc.) Z o <br /> o <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). o <br /> 3. Show dimensions In feet of thefollowing:(a) building to all lot lines,(b)buildingto center line of road,(c)building - <br /> measurement to the ordinary high water mark of lake,stream,or river. 0 <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. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I c m <br /> PLOT PLAN gdld 1p'xg l r To dek oz `o <br /> \ C4�a��' Aon <br /> 11 �l1/ <br /> pnefage Ia)( 2l,mmm6 rjer, deck n o e /CSerr�b ived7r a <br /> S�Uam PvRCi+) m <br /> � z <br /> a � <br /> u� <br /> See per'm,44t-- o <br /> n,a <br /> N <br /> nTV) 2 <br /> / v n <br /> I <br /> G <br /> nim <br /> of <br /> � 70�'� .a0 a m. S7 <br /> CONDITIONS OF PERMIT: ^ < Z `B o <br /> I. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o <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. of a p <br /> g: n V. <br /> C <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o : 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- (n m i+- m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- B o t3 <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I b(8 <br /> 0 . <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 ON 15 <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 o <br /> ) <br /> SIGN HERE �..�- - --�"— �•.-- ' .n <br /> UO(sign dure f owneror d' g contractor) r, ;; (date) oi <br /> N <br /> i. <br /> ZONING ADMINISTRATOR I ' 8 <br /> r�r� NH�H(gHM -I <br /> TOWNSHIP PERMI MAY BE REQUIREDm <br /> m <br /> ',l,\ $ 08 $ 88 $ 0ui <br />