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CV1- ("?- <br /> Burnett County 7410 Co. Rd. K, No. 702, Siren, WI 54872 Otflcs of Zoning Administrator a E o <br /> APPLICATION FOR — LAND USE — PERMITS - ' <br /> o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the $ O <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and _ <br /> regulations of the State of Wisconsin. w m <br /> m <br /> O <br /> OWNER TELEPHONE <br /> 0 <br /> ADDRESS <br /> r <br /> EMERGENCY/FIRE NUMBER ROAD NAM <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo 0 <br /> J r <br /> (, X36 ) (� Imo- o ? <br /> (Home/Cabin;Commercial Business' edroom;Deck;etc.) o 0 <br /> a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show t nel al7a of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). <br /> 0 <br /> s tens ti�etofffiefollowing:(a) 3-u ng 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. <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. o y <br /> Z c <br /> PLOT PLAN O ' <br /> C � <br /> a r <br /> C°C` + L-30 r III <br /> u J <br /> 4 tic" <br /> �� 3 <br /> G _ IL ,�dx7lE —la— 1 <br /> IC 1 —�1 g a°iel" 17 0 N I� <br /> I<�'I o <br /> I 4 � <br /> 60 3e <br /> r t] <br /> _ <br /> 71 <br /> l I <br /> -X R G <br /> f <br /> S yyyy yyyy <br /> / a T r <br /> run <br /> CONDITIONS OF P MR: 5�: 'Z C is g� ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z ° Z ' i XI <br /> 2, REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I� o �+ cj C, m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. - 25 E <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- O E C <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- 'ON « �" ' fm <br /> r1 <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. i <br /> motion I 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.I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described promises at any reasonable time for the purpose of inspection. ,n <br /> SIGN HER <br /> date) <br /> Ignaturo of owner r building cont <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY lllki REQUIRED 1 o rd ' $ �nl�'S m <br /> 88888888 ami <br />