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V 1 ' <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d '1 o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3_ <br /> TO THE ZONING ADMINISTRA R:The undersigned g hereby makes application for a Permit for the work described and � c � <br /> located as shown herein. The u dersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordin ce,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State Of Wisco isin. �, m <br /> OWNER L /L oa - 4, <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBERp ROAD NAME C <br /> LEGAL DESCRIPTION (see tax rec 'pt) H Itn (�- U �V+ <br /> Vi u _ <br /> CONTRACTOR /- . �\�/II <br /> TYPE OF PERMIT(S): DWELLING/ UILDING GARAGE CCESSORY TRUCTURE J< ADDITIONr p m " <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> o CL <br /> STRUCTURE/ADDITION USE: JO izA G C N E" o <br /> Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z ,, 1 <br /> o lv <br /> 0 <br /> m <br /> DIRECTIONS FOR PLOT PLA 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 wo II (W), septic tank (ST),and drainfield (D17. o <br /> 3. Show dimensions In feet oft iefollowing:(a) building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordiner r high water mark of lake,stream,or river. 0 4 <br /> 4. If separate plans are submit ed by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. O o <br /> NOTE. BUILDING/STRUCTURE LOOTIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11111 o wV' <br /> PLOT'PLAN Mwm oS o <br /> uo <br /> �r 'o(13' 7Lv /o — <br /> G� <br /> - <br /> ` <br /> m <br /> 4RKFLo ( f� CX/S�IvC 0 <br /> J 4)G j <br /> 5y H I <br /> j 3o <br /> Con,c� /rs., <br /> s�� s►.�,t -to <br /> Vrj�� f Z Oro�rX� <br /> t- ibe Burd; <br /> LAIY icy <br /> IT /Ivq �� D my raaoy <br /> ft /ZpS� C /C uo vty �k (/r)-eg �am am m <br /> 9 2 H = 77 <br /> CONDITIONS OF PERMIT: y ,z gc g0. r. <br /> 1. DRIVEWAY MUST MEET D IVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o £ oi �� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N O :om <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 informa- T <br /> tion contained in this applicatio (including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be rf lied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o'� <br /> further accept all liability which nay be a result of the County of Burnett relying on this information I am providing in this ap- <br /> plication.I agree to permit coun y officials charged with administering county ordinances or other authorized person to have O N p <br /> access to the above described I remises at any reasonable time for the purpose of inspection. mp a id, <br /> m <br /> SIGN HERE lC ^ - NE <br /> (sig to of owner or build' g contractor) date) !:(sig of owner or build' g contractor) date) !: I� <br /> ZONING ADMINISTRATOR <br /> yo} xE <br /> Cyt° k x-x <br /> ««« «as -n <br /> TOWNSHIP PERMITS MAY BE RECIUI ', ') o N Sx � egm <br /> --_-_� <br /> 0004, M o m <br /> 0 <br />