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n, "), <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator y o c c <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes — <br /> g by 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 requirements of the m c <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. <br /> c0 a m <br /> c <br /> OWNERI TELEPHONE /S" a J E <br /> C• O N <br /> ADDRESS ` OX, 3 1 S`Z $i'bt'J�uE12 rW SYYO� m <br /> EMERGENCY/FIRE NUMBER 139 / — ROAD NAME CTy t <br /> LEGAL DESCRIPTION (see tax receipt) SC' 24-7 V <br /> ;P2t� 1W .Silcef <br /> CONTRACTOR �� �'( KYO/ Ll,002000 <br /> Empyis �ArcT2ur-T ciA/ZjPoovER ct Cov Z-7' Z <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE__ ADDITION_%*4' __ p <br /> 0 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o` = <br /> STRUCTURE/ADDITION USE: BACK PeaC 1E -5TbR*4Er 1 /v 1V l2 L.I✓in!+ (ter' o = l\ <br /> (Home/Cabin;Commercial Business; Bedroom; eck;etc.) Z <br /> 0 0 <br /> 0 <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). 5 <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. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and Z) <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE0 VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 0 o m <br /> _ or �A+ <br /> N, e <br /> N_ <br /> O <br /> O,F �F(.rlt�.r C I <br /> 2.f&reox rA <br /> so In <br /> r s <br /> SX, s.r• ,, <br /> w <br /> - - <br /> o � <br /> Ait <br /> ' PnacH o <br /> �� \3 L <br /> vti' v►e� �; ick Q+ k� <br /> E.& <br /> f <br /> U81-LE <br /> - tlMrnnx <br /> m N D O In <br /> 40T 4'Vel Ai atit 300, g In <br /> CONDITIONS OF PERMIT: o m <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. e i T 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. N <br /> .v 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 9000p' : ' O ? m0 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs. a a •+ : m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- t 8 <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I ? ': gr$ 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> m <br /> L — m <br /> SIGN HERE- � i' 'A <br /> (aignatu o r or Du dip contractor) - -- ' (dote) <br /> ZONING ADMINISTRATOR <br /> �+M N�+MMfe�+ T <br /> TOWNSHIP PERMITS MAY BE REQUIRED o eN $N 'a' u^i$ m <br /> �I -- 88888888 Unn <br />