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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ; 3. o J <br /> APPLICATION FOR — LAND USE — PERMITS <br /> 70 THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and c <br /> located asshown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 3 n <br /> Burnett County land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and N o <br /> regulations of the State of Wisconsin. <br /> Fn y n C4- s O <br /> OWNER ^CJ ryLS�u, II I TELEPHONE ,� 12 — 57`11 -9C o.3 m <br /> TRC. ' i e- 4 v u hZ r-h 11 <br /> P, ry'\N ,V LION KG N\ Al D <br /> ADDRESS 1 L D 0 q 1� P, e. S 3 <br /> EMERGENCY/FIRE NUMBER ROAD NAME 14,t NS cu m L 0. �✓M,Iwo S I <br /> S <br /> LEGAL DESCRIPTION (see tax receipt) <br /> �fJJ II urr 1 <br /> CONTRACTOR i ate- Gv `�"u rr�C 1 <br /> -� ADDITION A�1 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING� GARAGE/ACCESSORY STRUCTURE `Ll <br /> m O <br /> n <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 `- <br /> r <br /> 0 <br /> 0 <br /> STRUCTUREIADDITION USE: C-2bv <br /> ercial Business;Bedroom; Deck;etc.) a a <br /> (Home/Cabin;Comm <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). o <br /> 2. Show the location of the well (W),septic tank (ST), and drainfleld (DF). I <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 h <br /> measurement to the ordinary high water mark of lake,stream, or river. -F- <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 0 i; <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR <br /> /O�NSfTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. Z a <br /> o <br /> PLOT PLAN QQc°tr To L-'y z <br /> . I o <br /> C I <br /> l� 0,0, tj <br /> I21 I o tC3 <br /> A <br /> A <br /> O <br /> ail of 11 be -� I <br /> N <br /> .wL j <br /> 0 <br /> r m <br /> O � <br /> y. <br /> ISI � _ <br /> E-- i�atis�drY, LctKe- ,- , 1Wa� —� <br /> oWv rD <br /> S K <br /> O <br /> SArJ gym; rel <br /> q3 SS— 33- 0 <br /> N - � 0 _ m <br /> g m <_.E <br /> < to , <br /> CONDITIONS OF PERMIT: p E : = W <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. 2 i O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. N S7 <br /> rn <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 0 : <br /> : B C <br /> g a): 9 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 'ow 0 «. <br /> it the data )S is .Ao ; O <br /> edge and belief it is true, I cation(including any accompanyd complete.I ing schedule)and I responsible <br /> that Idrecognaze thatcy of lthisontoar v _ o o . m <br /> tion contained in this app <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o o <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 e, <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized parson to have T 3 6 <br /> accesa to the above described premises at any reasonable time for the purpose of inspection. m : m AAp " <br /> SIGN HERE r"�— If ure of own . or build ng contractor) (date) <br /> Islg <br /> ZONING ADMINISTRATOR <br /> NSHIP P '^ T <br /> �NN (JNN V m <br /> OWRMITS MAY BE REQUIRED IU U� -- _ � '° v, <br /> oo $ $$ o 0 <br />