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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m c o <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> d o <br /> TO THE ZIONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. m <br /> c <br /> m O <br /> OWNER TELEPHONE o. gE <br /> ADDRESS <br /> of <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (seetaxreceipt�,'4.7"r— <br /> CONTRACTOR <br /> -O,'CONTRACTOR 7 <br /> TYPE OF PERMIT(S): /BUILDING J GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 ° <br /> o ^_ <br /> 0 <br /> STRUCTURE/ADDITION USE: 0 4 <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) f <br /> Z B LLl <br /> 0 c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> } <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). <br /> 3. Show dimensions in feet of thefollowing:(a)buildingto all lot lines,(b)building to center line of road,(c)building -1 <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. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I3 y <br /> c <br /> PLOT PLAN o n <br /> m y <br /> 0 <br /> C <br /> w <br /> m z <br /> w <br /> L <br /> S< e � �' <br /> n <br /> P <br /> fn <br /> O (A l] Wt- ➢ D g n7 <br /> m C m m o p <br /> ° > > n m ic <br /> CONDITIONS OF PERMIT: v m m C v0 m, o Sic <br /> m Z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE, o f : z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> In <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. : m n C <br /> $ a <br /> 1 declare that this application(including an accompanyingschedule has been examined b me and to the best of m knowl. o <br /> PP 9 Y 1 Y Y m : m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa. <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ m $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this ap- <br /> plication.I agree to ermit county officials charged with administering county ordinances or other authorized person to have O P p <br /> access to the ab escribed premises at an reasonabl ime for the purpose of inspection. m 8 8 l <br /> m : V A m i <br /> SIGN HERE <br /> w a <br /> (signet of o ner or bui ontractor) (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> (� (TNONOO ,`d' m <br /> $ $ 8 $ 8 8 8 $ rmn <br />