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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d/ f <br /> APPLICATION FOR - LAND USE - PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned here — ---� <br /> g by makes application for a Permit for the work described and <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 Ordnance,Sanitation Code, and with all other applicable County Ordinances and the laws art <br /> regulations of the State of Wisconsin. y m <br /> w � <br /> nO <br /> OWNER TELEPHONE _ _ E <br /> 0 m <br /> ADDRES _ _ r 9 t! 1 <br /> / r <br /> EMERGENCY/FIRE NUMBER ROAD NAM O <br /> 1 -SZ> <br /> LEGAL DESCRIPTION (see tax r ceip r <br /> I —1 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLIN /BUILDING X GARAGE/ACCESSORY STRUCTURE ADDITION o �� <br /> n 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo ° �1 <br /> 0 — <br /> m r- <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z v <br /> o ° <br /> IIIJJJ/{ � <br /> 9 <br /> N <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 (N). <br /> 2. Show the location of the well (W), septic tank (ST), and drainf laid (DF). <br /> 3. Show dimensions in feet dif 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. G <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. 0 i <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 04 o m <br /> PLOT PLAN Z c <br /> \ No KC ) <br /> C) s <br /> rn <br /> 00 <br /> o o 'Jh <br /> 41 <br /> vl <br /> m -c��irn of <br /> — - = fir mi <br /> g � a2 am m <br /> CONDITIONS OF PERMIT: o e <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o f .0 %'z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _S2 <br /> 3, NO GRADING OR SHO ELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. u7 n 0 : m <br /> a <br /> I declare that this applicatio (including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,cor act and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- «+a m <br /> tion Contained in this applic tion(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will b relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liability wh ch 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 c unty officials charged with administering county ordinances or other authorized person to have y N m <br /> access to thiiagove describ miles at any reasonable time for the purpose of inspection. <br /> � <br /> N Y <br /> SIGN HER / : «: » <br /> si atur of owner or ing contractor, <br /> K f E <br /> ZONI ADMINISTRATOR - - - S 8 : <br /> € <br /> TOWNSHIP PERMITS MAY BE REQUIRED APR 1 81994 m <br /> o o N g <br /> 000 «i�«o to <br />