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(5�) cc -t�P <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m -- 0 <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> W 57 <br /> o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 12 <br /> c J� <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 3 a <br /> regulations of the State of Wisconsin. = o <br /> w m <br /> m <br /> OWNER /1r`e DTELEPHONE � � _. �1� o f11 O <br /> �1 1/ <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> i <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> O <br /> SANITARY _ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> r <br /> STRUCTURE/ADDITION USE: o ° <br /> (Home/Cabin;Commercial Business;Bedroom:Deck;etc.) Z v <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). <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). OCi i~ <br /> 3. Show dimensions infeet of thefollowing:(a) buildingto all lot lines,(b)buildingto center line of road,(c)building -0 J <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 2 <br /> dated by the owner. <br /> 00 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 5 u: <br /> c <br /> PLOT PLAN '111o a <br /> fn o 0 <br /> d � <br /> N <br /> N <br /> N <br /> I <br /> I <br /> J AO c W r rni a <br /> CONDITIONS OF PERMIT: ? < y. Z C on g <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o f o -Z -{ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMI-TTED. : , m <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- W m 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- .n m«. <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- �J. 9 a 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 i Olt 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 a - <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> 0" 0: <br /> access to the above described premises at any reasonable time for the purpose of inspection. N O 0 <br /> m Ev0 <br /> a m pp <br /> SIGN HERE _ - <br /> (signs ure of owner or building contractor) _. - - N <br /> '- <br /> 0 <br /> ZONING ADMINISTRATOR f <br /> TOWNSHIP PERMITS MAY BE REOUIR L; iJ O N m N a m <br /> og o rn <br />