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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 0 _ <br /> o <br /> TO THE ZONING 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 Ordina ce,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. v, m <br /> c <br /> O <br /> OWNERTELEPHONE F <br /> v <br /> ADDRESS0-3 ^ _ W D <br /> EMERGENCY/FIRE NUMBER ROAD NAME '�- <br /> I <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n f7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 ° <br /> r <br /> STRUCTURE/ADDITION USE: 0 <br /> 0 <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) z o <br /> 0 0 <br /> DIRECTIONS FOR PLOT PLAh 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). I� <br /> 2. Show the location of thew II (W),septic tank (ST), and drainfield (DF). –Z <br /> 3. Show dimensions in feet oft efollowing:(a) building to all lot lines,(b)buildingto center line of road,(c)building 14 <br /> measurement to the ordinary high water mark of lake,stream, or river. C <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. <br /> 00 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 9I o ur <br /> Z o <br /> PLOT PLAN ? <br /> A ' s <br /> m a <br /> C l <br /> a � _ <br /> 1'Oy� m <br /> -�('/�Crti - <br /> > f Il7 <br /> n_ <br /> 0 <br /> O <br /> 0 <br /> O y <br /> H <br /> nIW1 Z <br /> O,c W 0 a F Im <br /> 0 Qmm <br /> CONDITIONS OF PERMIT. <br /> c <br /> 33 2. <br /> 0inc � <br /> 1. DRIVEWAY MUST MEET D IVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o m o `z <br /> 2. REMOVAL OR CUTTING O TREES AND VEGETATION Is RESTRICTED ALONG SHORELINE. F 0 =t y 77 <br /> h <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o _ V7 n O <br /> is <br /> 1 declare that this application(ir cluding any accompanying schedule)has been examined by me and to the best of my knowl- o' C <br /> edge and belief it is true,correc and complete.I acknowledge that I am responsible for the detail and accuracy of all informa. e+ro ur m <br /> tion contained in this applicati (including any accompanying schedule)and I further declare that I recognize that this infor- a <br /> mation I am providing will be r lied upon by the County of Burnett Wisconsin in determining whether to issue a permit. r, o 19 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 ap- <br /> plication.1 agree to permit cour ty officials charged with administering county ordinances or other authorized person to have <br /> 0" 0: <br /> access to the above described remises at any reasonable time for the purpose of inspection. 3 0 <br /> '.w.� J 0 0 O 0 <br /> SIGN HERE ♦iIN9+ _� _ "I�- _--' �' ` �'" o : E <br /> t!'/date)'. <br /> ZONING ADMINISTRATOR <br /> � APR TTOWNSHIP PERMITS MAY BE REQUIRE61 <br /> mN <br /> 00000000 <br /> U) <br /> i <br />