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/ J <br /> Burnett County 7,410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator (r", l go )',V a <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> d <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> O c <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 Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. o <br /> w m <br /> w � <br /> c <br /> OWNER aOAIVIgo VE N f a' ,�TTELEPHO/N!E (�R,ilzf-q3� - 4f bq n O <br /> ADDRESS 12110 t'.O14e 6Ae DI? MIn1NG IO�Kt1y f try S�'.�>�.� m <br /> EMERGENCY/FIRE <br /> NUMBER h)i('5T i$ ROAD NAME 0 djEK�A/JD JW <br /> LEGAL DESCRIPTION (see tax receipt) V <br /> CONTRACTOR Ir.Lr f <br /> TVP OF PER T(S : FEEING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p - <br /> 0 o J <br /> SANITARY FILLING/GRADING CAMPING UNIT SUBDIVISION o` = <._ <br /> '^ r <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z v <br /> o ° <br /> I� o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) r <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). <br /> 3. Show dimensions in feet ofthefollowing:(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 <br /> dated by the owner. 0 0 <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I 3 w <br /> PLOT PLANz <br /> � o a <br /> M o <br /> C <br /> w <br /> � : <br /> m <br /> 0 <br /> N <br /> O <br /> ° <br /> n <br /> O <br /> ti <br /> \_Z <br /> Cy <br /> � fA UI V rnrDD � <br /> m n tt m <br /> a a m 77 <br /> CONDITIONS OF PERMIT: v m < m C m o <br /> I. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F ? 9� ? <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �+� L7 O <br /> C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my know[ <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- m <br /> w u+ I <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- _. 8 m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I i 8 m 8 <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 O o <br /> access to the abov described premises at any reasonable time for the purpose of inspection. 3 8 2 <br /> T <br /> SIGN HERE a4J S — <br /> (signature of own o build contraw <br /> (date) <br /> ZONING ADMINISTRATOR ( (� i 11 <br /> TOWNSHIP PERMITS MAY BE REOUIRED�bII I JUN 2 9 ,992 <br /> � U � 88 8888vmi <br />