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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes m <br /> g by 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 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. o <br /> m m <br /> OWNERI �- TELEPHONE <br /> £ <br /> O � <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) / <br /> 111' ) <br /> CONTRACTOR f\ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> o < <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial mess;Bedro ;Deck;etc.) Z <br /> o ° <br /> 0 <br /> m <br /> 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 2) <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). <br /> 3. Show dimensions infeet ofthefollowing:(a)building to all lot lines,(b)buildingto center line of road,(c)building O <br /> measurement to the ordinary high water mark of lake,stream, or river. <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 Q <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on a N <br /> c <br /> PLOT PLAN o n <br /> Jz <br /> Jz <br /> M �1J <br /> I <br /> � N <br /> m <br /> ° <br /> 0 <br /> N <br /> O <br /> 7 <br /> J <br /> 0 y <br /> N <br /> Z <br /> I D <br /> O cc'c�W r 0a <br /> Q0 <br /> DO.`G O-� � <br /> 'O. Q m <br /> CONDITIONS OF PERMIT: ? 3.; 12 c o .0C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F �� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. i '• In <br /> g ? i sBE E C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <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«; <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. B m <br /> g m <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. i o g <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.1 agree to permit county officials charged with administering county ordinances or other authorized person to have Q N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> m v <br /> $A I <br /> `a m <br /> « € ` m o : <br /> 4 HERE ' <br /> yC (signature of ow er or building contractor) (date) ': o- .8 <br /> � ,, _ l � � <br /> OMINISTRATOR �.l Ian I r-iTN 16A J )E E <br /> TOWNSHIP PERMITS MAY BE REOUIRED N 0 m <br /> 0000 <br />