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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 'aE o <br /> APPLICATION FOR — LAND USE — PERMITS - . <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work desci ibed and � a 0 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requireme its of the <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and _ O <br /> regulations of the State of Wisconsin. H m <br /> OWNERM(tM� - <br /> O <br /> <. { U' TELEPHONE <br /> r £= <br /> ADDRESS /e I S- I <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) `I(� <br /> CONTRACTOR - I <br /> TYPE OF PERMIT(S): DWELLING/BUILDING _ GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> 2 o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> _ <br /> r <br /> STRUCTURE/ADDITION USE: g <br /> (Home/Cabin;Co mercia; usiness;Bedroom; Deck;etc.) <br /> Z o <br /> o <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). <br /> 2. Show the location of the well (W),septic tank (ST),and drainfiaid (DF). o <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c) building yl <br /> measurement to the ordinary high water mark of lake,stream, or river. <br /> 4, it separate plans are submitted by an architect,engineer,builder,contractor,etc.,the pians must be signed and � <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 0 UED. G v N <br /> PLOT PLAN o a <br /> m o <br /> ZZ Z <br /> I60' 4-b a/L/u/ ��i ))'(1 C_ _ <br /> z <br /> V 1 � <br /> 1 <br /> f <br /> 2.In <br /> m - g� �am <br /> CONDITIONS OF PERMIT: o 3:: Z C 1 g -' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F E � <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. rr 11 11 —N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- : ^E C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of a 1 informs- i i T <br /> 'on contained in this application(including any accompanying schedule)and I further declare that I recognize that his infor- $ B p <br /> ition I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue permit. I Igr$ $ <br /> cher accept all liability which may be a result of the County of Burnett relying on this information I am providing in this ap- <br /> ition.I agree to permit county officials charged with administering county ordinances or other authorized person to have p <br /> is to the above described premises at any reasonable time for the purpose of inspection. 0i <br /> 0 <br /> (sl nature of owner or building nuactoq <br /> a 1_ <br /> iMINISTRATOR r�-J <br /> $i <br /> TOWNSHIP PERMITS MAY BE REQUIRED APR I O <br /> ONINr1 Or,NnN N <br /> �I 8888888 <br />