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Bum*" County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Offiq of Zoning Administrator C m o <br /> APPLICATION FOR — LAND USE — PERMITS �. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w ° <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Lara!Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and �. <br /> regulations of the State of Wisconsin. m <br /> OWNER '�'" D I' 44 t L-£57-5- 76�-o a `= O <br /> �J 0 k ei +7�N Y ) / C4 10�i e TELEPHONEtj Col's Ci}i0 �^If 13 o <br /> ADDRESS 5t4j t�upOu-1-AO> " 11\ <br /> EMERGENCY/FIRE NUMBER ��( ��� ROAD NAME CL0efk G <br /> U 4It, Jnk �Q QQQ <br /> LEGAL DESCRIPTION (see tax receipt) _ S <br /> / n f] 1.e+1 blkl o F I.e ak V1A�ekc��fe sub�forsron� -� <br /> CONTRACTOR y W44 14*W1 /�eG'6P.AT7isd hawteS <br /> 00 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURES ADDITION p <br /> n <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> o 0 <br /> STRUCTURE/ADDITION USE: —C,6,-w - CACY t S50/11 46nal-Q <br /> (Home/Cabin;Commercial Business;Bedroo D k;etc.) <br /> Z o' <br /> o <br /> _ m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 00 <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 (VI),septic tank (ST),and drainfield (DF). <br /> 004 0 <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building 1A <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 signed and 0 <br /> dated by the owner. C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 3 N <br /> Z <br /> PLOT PLAN c cn <br /> A La <br /> 'act C <br /> a well c <br /> _ <br /> N <br /> O <br /> 1 �CrL ` l <br /> lower MckuuZ+�G l2aad �'�"� 8 Df m <br /> CONDITIONS OF PERMIT: v_ y-: g 9- <br /> i. <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. F = = <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m <br /> a <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o . fi <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 ro«. <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. p <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $� $ <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.Iagree to permit county officials charged with administering cow t i reon to have O p <br /> access to the above described premises at any reasonable time for the r n <br /> Tt E 3 j( <br /> J m <br /> SIGN HERE N <br /> (signa�f owner or bullding contractor) APR 3 1918 <br /> ZONING ADMINISTRATOR �r COUNTY r�/ <br /> gg �� 1 1 COUN � i NNN~NNiN� Zt <br /> TOWNSHIP MITS MAY BE RE�UI NTNG o `" v, `""" m <br /> 088808'8'8 H <br />