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ON COMPU 'EP/SCANNED 7L COM? <br /> Bume!t County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator � M o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3" 0 <br /> o <br /> 1-0 THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> ocated as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> 3urnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> egulations of the State of Wisconsin. y o <br /> C S <br /> m �77 o <br /> OWNER a TELEPHONE 1 p <br /> kDDRESS <br /> S <br /> :MERGENCY/FIRE NUMBER ROAD NAME <br /> 0 <br /> _EGAL DESCRIPTION (see tax receipt) .. ` _ ` ' (A <br /> CONTRACTOR t �f) Cc) <br /> TYPE OF PERMIT(S): DWELLING/BUILDING J(I — GARAGE/ACCESSORY STRUCTURE_ ADDITION <br /> I 0 <br /> iANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> o-Ne <" <br /> STRUCTURE/ADDITION USE: {� 1 ° o <br /> (Home/Cabin;Commercial Business;Bedroom; v <br /> Deck;etc.) Z d <br /> o v <br /> m <br /> e � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) f� <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),septic tank (ST), and drainfield (DF). o <br /> 3. Show dimensions in feet of the following:(a) building 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. 0 — <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. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 10 cn <br /> Z Q <br /> PLOT PLAN o a <br /> m o <br /> c <br /> tj <br /> n <br /> 0 <br /> I <br /> N <br /> o r <br /> ro <br /> 07- 038- oaIo00 <br /> Oaf'000 <br /> tJ� <br /> L it+le $.caf AACk <br /> ,Molar -t-Z$ <br /> �.m o <br /> n — p. 2.P-m m m <br /> M -" N <br /> CONDITIONS OF PERMIT: < E' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o f n� <br /> �_ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. M <br /> — <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o ': p <br /> ` o : n. <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my know) o m iD = C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa �+►m�' m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this inform . p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. o`� $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this aA` !� <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have n p <br /> access to the above described mises at any reasonable time for the purpose of inspection. 3 m " <br /> CD CD : <br /> co <br /> SIGN HERE = ` <br /> (sign!!?jAo#ow r or building contractor) (date)kAan <br /> a' <br /> ZONING ADMINISTRATOR <br /> to 6) K) K) <br /> TOWNSHIP PERMITS MAY BE REQUIRED — o b 6 ' 5 <br /> n$ oo " g 8 8 rn <br />