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cin-cam. <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. ' <br /> o <br /> TO THE ZONING ADMINIST TOR:The undersigned hereby makes application for a Permit for the work described and m <br /> located as shown herein. The indersigned agrees that all work shall be done in accordance with the requirements of the m •, <br /> Burnett County Land Use Ordit iance, Sanitation Code, and with all other applicable County Ordinances and the laws and n <br /> regulations of the State of Wisconsin. y m <br /> w � <br /> c <br /> n O <br /> OWNERq TELEPHONE <br /> r1 0 ' <br /> ADDRESS O C)13C, gr <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax re eipt) Vj <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLIN /BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o (j'C <br /> O ( lj <br /> SANITARY _ PRIVY FILLING/GRADING CAMPING UNI SUBDIVISION o ° <br /> r <br /> STRUCTURE/ADDITION USE: II I I, =1- r�Tl+ o g <br /> (Home/Cabin;C mmerciel Business;Bedroom; eck;etc.) Z o <br /> o <br /> DIRECTIONS FOR PLOT PLJN DRAWING: (Aerial or top view) <br /> 1. Show the location and sh a of all existing buildings (EB) and all new buildings (NB) and indicate North (N). <br /> 2. Show the location of the 1 veil (W), septic tank (ST),and drainfield (DF). IWWW, <br /> 3. Show dimensions in feet o thefollowing:(a) building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordin try high water mark of lake,stream,or river. �} <br /> 4. If separate plans are sub itted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. G a <br /> NOTE: BUILDING/STRUCTURE LC CATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '1I 3 N <br /> c <br /> _ Z o <br /> PLOT PLAN n _ a <br /> M ( 0 <br /> C <br /> �tCfl� �o m <br /> I � <br /> -� o <br /> N <br /> 0 <br /> a <br /> N_ <br /> l ? <br /> D <br /> C <br /> is <br /> N O,c N r A a * <br /> v m2_. s' Cy Dos r+ <br /> CONDITIONS OF PERMIT: < m T $ . ro <br /> . <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o E o �'z � i —1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - =Nin: <br /> Nim m <br /> 3. NO GRADING OR SHO LAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �j 2 n kp; <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,convict and complete.I acknowledge that I am responsible for the detail and accuracy of all informal- m <br /> tion contained in this applica ion(including any accompanying schedule)and I further declare that I recognize that this infor- E `� a p <br /> mation I am providing will bi relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $� <br /> further accept all liability whi h may be a result of the County of Burnett relying on this information I am providing in this ap- <br /> plication.I agree to permit cc unty officials charged with administering county ordinances or other authorized person to have 00 v <br /> access to the above clescritic d premises at any reasonable time for the purpose of inspection. _ T 3 0 <br /> m <br /> SIGN HERE D �' i w a <br /> ZONING ADMINISTRATOR <br /> a >$ xyf- <br /> 000 0 <br /> 00 0)00 A5 0 Ch <br /> 1 �N NNUM <br /> �gl � <br /> TOWNSHIP PERMITS MAY BE REOUIR u o u n fl u U ]N So m <br /> w <br /> 0 <br />