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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator -0 o c <br /> APPLICATION FOR - LAND USE - PERMITS <br /> m ° <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and o <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 with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. <br /> w <br /> n O <br /> OWNERr TELEPHONE o <br /> m <br /> ADDRESS I 1g <br /> a ) <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR �'L ��yw <br /> �f�.n 1. \ � _ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSO Y STRUCTURE ADDITION p <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> J <br /> w r <br /> STRUCTURE/ADDITION USE: S ° <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) z <br /> o ° <br /> a <br /> m <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). r <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). o <br /> 3. Show dimensions In feet of the following:(a)bullding 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 M <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSrrE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 91 3 y <br /> PLOT PLAN ? <br /> o a <br /> M � <br /> c�h R&" w <br /> M <br /> o� <br /> m <br /> o <br /> I <br /> f <br /> 8 myv(nr DD � v <br /> a Da•. '2--aa 2t M <br /> CONDITIONS OF PERMIT: m- Z o =0a'o <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. '' i"n ; Q rn <br /> rn <br /> 8i iC <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- S E o m <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informs- m�" m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation <br /> G <br /> I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a Permit. <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- .1 <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have N - <br /> access to the above described premises at any reasonable time for the purpose of Inspection. m <br /> m a A w <br /> SIGN HERE - w 8 <br /> (signature of own r or building contractor) (date) ': a <br /> ZONING ADMINISTRATOR —J . <br /> TOWNSHIP PERMITS MAY BE REOUIRED iG N iN o o m <br /> $ 8888888rn <br />