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Sumett County 7410 Co. Rd. K. No. 102, Siren,WI 54872 Office of Zoning Administrator — N o O o <br /> APPLICATION FOR — LAND USE — PERMITS 5. 0 <br /> f0 THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v v <br /> orated as shown herein. The undersigned egress that all work shall be done in accordance with the requirements of the � $ <br /> 3urnetl County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and <br />,egulations of the State of Wisconsin. m <br /> 'f � c g <br />)WNER SRr4ET Lkrr7— TELEPHONE �-J I _ �,SZ $ >_ <br /> m_ m <br /> IDDRESS 2—S601$ KI KARL "iD 21`145UR9 _ Wt . S`4830 e <br />=MERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> I <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o G <br /> n O <br /> SANITARY PRIW FILLING/GRADING CAMPING UNIT SUBDIV ION o` °. <br /> ° <br /> STRUCTURE/ADDITION USE: rl�' Jd ac- ° o <br /> (Home/Cabi ,Commercial Business; Bedroom;Deck;etc.) o 0 <br /> 0 <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 North (N). r <br /> 2. Show the location of the well (VV),septic tank (ST),and dralMield (DF). 4 <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)buildingI pQ <br /> measurement to the ordinary high water mark of lake,stream,or river. <br /> 4. N separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrrE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 a y <br /> 11 2 0 <br /> PLOT PLAN ° n <br /> �}ITACI}ED <br /> C 4 <br /> �j59 oo <br /> r <br /> 1 � R <br /> 8 0 <br /> IN <br /> ° I� <br /> m <br /> { lO <br /> z <br /> cn� d2f c. <br /> 1 � <br /> ELr � m <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. e ! i; i -zi i <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. Ii .... 0EI declare that this application(including any accompanying schedule)has been examined by me and to the best of my knoedge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all infor �"m �'; mtion contained In this application(Including any accompanying schedule)and I further declare that I recognize that this inmotion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a perm $further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to h <br /> access to the above described promises at any reasonable time for the purpose of inspection. T <br /> i <br /> SIGN HERE {Aate)man-F fir h. <br /> i MI <br /> ZONING ADMINISTRATOR t i ` ' <br /> P �M •wrti� T <br /> TOWNSHIP PERMITS MAYBE REQUIRE I �fo 1' a' a'LU"$ m <br />