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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m ' o c <br /> APPLICATION FOR - LAND USE - PERMITS 3 <br /> 0 <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 m <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. T N <br /> OWNER v/�M,�J O �G TC/��ON TELEPHONE £ <br /> �J �l //� n 7� /+ Qom.;+✓ p v <br /> ADDRESS.L s�0 L 3 ifO zI TY 4 M. l.. <br /> EMERGENCY/FIRE NUMBER ROAD NAME 1� I <br /> LEGAL DESCRIPTION (see tax receipt) ^ (� <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p V <br /> n o <br /> SANITARY,)C PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> 0 <br /> STRUCTURE/ADDITION USE 1 g o <br /> (Home/Cabin;Commercial Busined, Bedroom; De ,etc.) Z v <br /> 0 0 <br /> a <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 (DII o <br /> 3. Show dimensions in feet of thefollowing:(a)buildingto all lot lines,(b)building to center line of road,(c)building -q <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 0 <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED, 1I 3 N <br /> c <br /> PLOT PLAN o a <br /> m <br /> 0 <br /> C I <br /> M W <br /> 6` <br /> 0 <br /> O <br /> i <br /> � y <br /> 0 <br /> IN <br /> 's <br /> 0 <br /> Z <br /> i <br /> 1 <br /> o c 0 d o a : m <br /> CONDITIONS OF PERMIT: v < < m o. tp <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 5 r12 . <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. r^ m <br /> 1 NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED, 'm g " : C c <br /> a � <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m '� m <br /> edge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I s m s <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- <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O N p <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> 3 g g <br /> m V A N <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR `S <br /> l � i SEP r)r�l) <br /> TOWNSHIP PERMITS MAY BE REOUIREDI! '; - )' ^ N N o ,'o S' m <br /> '�,!',.',1.. . g g g g g m <br /> v <br />