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on cam/ <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U m o a <br /> APPLICATION FOR — LAND USE — PERMITS <br /> 0 <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 theM C <br /> Burnett County Land Use Ordin nce, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. H m <br /> w � <br /> c00 <br /> OWNER , Q o <br /> ADDRESS C <br /> EMERGENCY/FIRE NUMBERL, BROAD NAME .S _ <br /> LEGAL DESCRIPTION (see tax rec)ipt) <br /> CONTRACTOR <br /> C-' S <br /> TYPE OF PERMIT(S): DWELLING/ UILDING GARAGE/ACCESSORY STRUCTURE P**' ADDITION p <br /> n 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION _ 0 <br /> o < <br /> 0 <br /> STRUCTURE/ADDITION USE: d S o 2 <br /> (Home/Cab' ; Commercial Busi ss;Bedroo eck;etc.) Z v <br /> 0 0 <br /> a <br /> m <br /> DIRECTIONS FOR PLOT PLA I DRAWING: (Aerial or top view) <br /> 1. Show the location and siz of al existin buildings (EB) and all new buildings (NB) and Indicate North (N). <br /> �� ( and draine (DF). o_ <br /> 0 owing: a ulldinding to all lot lines, <br /> (b)building to center Zine of road,(c)building � <br /> measurement to the ordinal y high water mark of lake,stream, or river. C <br /> 4. If separate plans are submit ted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LCK ATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 a w <br /> c <br /> PLOT PLAN o a <br /> cn <br /> 30' <br /> port 8' 2°f' 13r <br /> '3 m <br /> Noble 2y ' 0 <br /> i <br /> IN <br /> i 0 <br /> GJ w <br /> 33' <br /> d <br /> O <br /> J <br /> ToavN oa � A 0am <br /> = 3) <br /> CONDITIONS OF PERMIT: ? ,z CS =2 <br /> 1. DRIVEWAY MUST MEET D IVEWAV WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o m o 9Q2. REMOVAL OR CUTTING O TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. F a =N <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. u' : 2 P: m <br /> $ ' ag ` C_ <br /> I declare that this application fir cluding any accompanying schedule)has been examined by me and to the best of my knowl : ° m <br /> edge and belief it is true,correc and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this applicatio i(including any accompanying schedule)and I further declare that I recognize that this infor- $ g p <br /> mation I am providing will be r lied 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 cour ly officials charged with administering county ordinances or other authorized person to have i0 N p : <br /> access to the above ribed mixes at any reasonable time for the purpose of inspection. 0 °br 0 <br /> we <br /> SIGN HERE <br /> ( tura of ow or building contractor) � J (date) v h <br /> o ? x <br /> x : <br /> ZONING ADMINIST OR �- +f <br /> TOWNSHIP PERMITS MAY BE REQUIRED I' Z5 Z5 <br /> obb oMM <br /> ua <br /> 0 <br />