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Ili 071 ce"Xi <br /> Burnett Cainty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m o 0 0 <br /> APPLICATION FOR - LAND USE - PERMITS > <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work desc ibed and w - <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requireme nts of the m — <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and �. $ <br /> regulations of the State of Wisconsin. w m <br /> n f w o <br /> OWNER iI�V e.��^ TELEPHONE �IS— SM - I U 1 0 7. 1 <br /> ADDRESS o , <br /> EMERGENCY/FIRE NUMBER ROAD NAME tn" <br /> LEGAL DESCRIPTION (see tax receipt) +' <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION } g <br /> n <br /> SANITARY PRIVYoO <br /> FILLING/GRADING CAMPING UNIT SUBDIVISION o` <br /> w � <br /> STRUCTURE/ADDITION USE: 0 4 <br /> (Home/Cabin;Comm lel Business;Bedroom;Deck;etc.) _ <br /> 0 0 <br /> m <br /> 3 <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 (f). <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (Di <br /> 3. Show dimensions In feet of the following:(a) building to all lot lines,(b)building to center line of road,(c I building <br /> measurement to the ordinary high water mark of lake,stream,or river. <br /> O I/l <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sl ned and i <br /> dated by the owner. <br /> 4 1 We , <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE UED. 1I o N <br /> PLOT PLAN o n <br /> !1 < <br /> fA o <br /> C <br /> itIo <br /> �-Y o <br /> _ <br /> o <br /> _ <br /> m <br /> n <br /> ( w <br /> F <br /> saFma <br /> CONDITIONS OF PERMIT: o c g <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p E NT <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> qQ i E ` E C <br /> 5f <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,correct and complete.I acknowledge that I am responsible for the detail and accuracy of II informs- «a «; m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize thal this infor- <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 i $°� $ <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 permit county officials charged with administering county ordinances or other authorized person to have o <br /> access to the above described premises at any reasonable time for the purpose of inspection. Q <br /> -n <br /> SIGN HERE <br /> (signature of ow er or bulldln n tort (date) <br /> ZONING ADMINISTRATOROi <br /> TOWNSHIP PERMITS MAY BE REOUIRED o <br /> N �Nn. . <br />