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C9Yl�Y�' <br /> Burnett Coynty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m a 0 <br /> S 1 <br /> APPLICATION FOR — LAND USE — PERMITS m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and a <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requireme its of the MV C <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the awe and <br /> regulations of the State of Wisconsin. m m <br /> a, m <br /> yyy C <br /> OWNER TELEPHONES _ 8 <br /> U m � <br /> ADDRESS cSID <br /> EMERGENCY/FIRE NUMBER <br /> LEGAL DESCRIPTION (see tax receipt) '-_-- <br /> CONTRACTOR <br /> .,j <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> L) <br /> SANITARY _ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> 11 II/ H r <br /> STRUCTURE/ADDITION USE: i /X <br /> (Home/Cabin;Commercial Business; Bed ` ;Deck;etc.) v <br /> 0 0 <br /> v <br /> DIRECTIONS FOR PLOT PLAN 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 well (W),se is tank (ST), and dratnfield t7. <br /> 3. how mena nsinfeetofthefoIlowfng:(a)buIIdtngtlis,(b)b u I I It I It g to ce nte I I I n a of roa cl,(c) It u I I III I n g <br /> measurement to the ordinary high water mark of lake, stream,or river. <br /> 4. H separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be all ined and <br /> dated by the owner. 0 0 <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 13SUED, an 3 rn <br /> c <br /> PLOT PLAN o 'o <br /> W H <br /> C ' <br /> 5- <br /> I <br /> h� <br /> m <br /> '-1 0 <br /> � i <br /> N ' � <br /> O <br /> O � <br /> N <br /> Z <br /> I <br /> e $� H 4 In <br /> CONDITIONS OF PERMIT: o 3: Q firc B 8 M <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. = o Q <br /> o F ' <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. cy <br /> 3. NO GRADING OR SHOREIAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. rQa O 0 <br /> � . <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- '. O i C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of a I informs- X1 <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that his infor- 8B p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 8'$ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing In this&p- <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 premises at any reasonable time for the purpose of inspection. <br /> I M <br /> N w <br /> SIGN HERE <br /> ( aturo of owner or Suffiding contr o a (date) <br /> ZONING ADMINISTFU OR TM <br /> M N <br /> m <br /> TOWNSHIP PERMITS MAY BE REQUIRED o g g <br /> $ $ 8 $8888ai <br />