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o► (OV <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator w '1 a a <br /> APPLICATION FOR — LAND USE — PERMITS . <br /> S; 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v o <br /> w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the w at <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. �, G� <br /> w m <br /> c (� 0 <br /> n <br /> OWNER POS ld f' �(b TELEPHONE O� — �IR� <br /> rA o <br /> �7 1 , <br /> ADDRESS Zzq(o P4`BOIS <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> 1 <br /> LEGAL DESCRIPTION (see tai receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION 0 <br /> 0 <br /> SANITARY__>(_ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> J <br /> w � <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z o <br /> 0 0 <br /> Q <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 drainfield (DF). PC <br /> 3. Show dimensions in feet of 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. 0 <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. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. an 3 rn <br /> 71 z `v <br /> PLOT PLAN ° n 7 n <br /> m a <br /> a _ <br /> N <br /> A <br /> n <br /> O <br /> J <br /> N <br /> O <br /> J <br /> J <br /> Z <br /> is <br /> w D— , � w <br /> CONDITIONS OF PERMIT: ^ m Q C6 3: <br /> I. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 0 i it <br /> H - <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N ' S <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o �2 O <br /> o : aEE <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o'; m � : C <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- d+m.n m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $� 0 . <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- d, <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have n cam„ o <br /> access to the above described premises at any reasonable time for the purpose of inspection. T ? 3 S x <br /> SIGN HERE <br /> (signatuft of owner or building contractor) W (date) r� <br /> ZONING ADMINISTRATOR "r �� SEP <br /> TOWNSHIP PERMITS MAY BE REQUIRED N St 8 m <br /> N <br />