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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o Q <br /> -APPLICATION FOR — LAND USE — PERMITS3. <br /> d a <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the mc <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and 3 0 <br /> regulations of the State of Wisconsin. <br /> c <br /> n O <br /> OWNER fog TELEPHONE F <br /> ff J <br /> ADDRESS ll25�! �'t'll�_.ol/ <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> 2) <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION I r) o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION -o <br /> J <br /> r <br /> STRUCTURE/ADDITION USE: � °^ <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z <br /> 0 0 1 f <br /> 11 1 <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). J <br /> 2. Show the location of the well (W), septic tank (ST), and dreinfield (DF). DO <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)buildingto center line of road,(c)building ILn <br /> measurement to the ordinary high water mark of lake,stream, or river. Q <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. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on a to <br /> c <br /> _ Z v <br /> PLOT PLAN 0 a <br /> C O <br /> N <br /> � G_ 00 <br /> N n 7 <br /> o <br /> J <br /> J <br /> m rt ' <br /> I <br /> 2 O,c <br /> mJ- am Q = y <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o $= 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =2 i m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o @ n O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o rI C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- '^m" : T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B g ; p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o ig o <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- i <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have O N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 0 3r' <br /> m A N <br /> SIGN HERE '"4 �� � ur w-8 <br /> (signs re of owner or building contractor) I i (date) o : x 3 <br /> ZONING ADMINISTRATOR OCT <br /> TOWNSHIP PERMITS MAY BE REOUIRED N N N m <br /> f0000 0(1) <br />