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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m ; c <br /> m 3 <br /> APPLICATION FOR — LAND USE — PERMITS . <br /> o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v w <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 w'fff(((hhh all other applicable County Ordinances and the laws and n <br /> regulations of the State of Wisconsin. /f <br /> TELEPHONE10 <br /> V <br /> ADDRESS � l e!' .�'-r/S, �/✓G�� � I�� /,,` ./ = I I;n . <br /> EMERGENCY/FIRE NUMBER ROAD NAME 77 <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE(ACCESSORY STRUCTURE ADDITION p <br /> o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 'C <br /> `^ r <br /> STRUCTURE/ADDITION USE: $ ° <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top vl ) o W <br /> 1. Show the location and size of all existing buildings ( and all new building NB) and Indicate North (N). <br /> 2. Show the location of the well (W), septic tank (S nd drainfield (OF). o_ <br /> 3. Show dimensions in feet of the following:(a)but ng to all lot lines,(b)bu ngto center line of road,(c)building -q <br /> measurement to the ordinary high water m of lake,stream,or riv <br /> 4. If separate plans are submitted by an itect,engineer,builder, ntractor,etc.,the plans must be signed and ( h <br /> dated by the owner. 0 1 <br /> NOTE, BUILDING/STRUCTURE LOCATIO MUST BE STAKED FOR O E VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a m <br /> PLOT PLAN 11 o 'a <br /> O ' <br /> M o <br /> C I <br /> m <br /> � f s w <br /> z <br /> o` <br /> o <br /> $ A. <br /> ,lJ <br /> m fn � t/� r > p <br /> a n O C < 7 7 O F <br /> CONDITIONS OF PERMIT: v A <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ »� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m » `. --C <br /> g : <br /> 0- <br /> I <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- i 8= u, <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ 8 <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- w <br /> plication. I agree to perm unty offici Is charged with acoini5tering county ordinances or other authorized person to have O a p <br /> access to the above d..Xroed pre7istl at an easona It i9e for the purpose of inspection. <br /> M V A N <br /> 8 : <br /> SIGN HERE <br /> (510'! of owner o g contractor) Maplll f7 ILE FN) <br /> ZONING ADMINISTRATOR cn `--.__._.._._._ <br /> TOWNSHIP P RMITS MAY BE REOUIREt)f <br /> V 888888 8 <br />