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Burnett County 7410 Co. Rd. K, No. 102, Siren, W154072 Office of Zoning Administrator W E o <br /> APPLICATION FOR — LAND USE — PERMITS0— _ <br /> m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described.and m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the $ j <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws.,and _ <br /> regulations of the State of Wisconsin. w m <br /> m' <br /> / O <br /> OWNER TELEPHONE <br /> 0 <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER sem) ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR —tr�— <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE L� ADDITION o ` <br /> m <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNITSUBDIVISION 0 0 <br /> STRUCTURE/ADDITION USE: <br /> (Ho /Cabin;CoslWercial Business;Bedroom;Deck;etc.) z o <br /> o v <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 <br /> 2. Show the location of the well (W),septic tank(ST),and drainfleld (DF). o <br /> 3. Show dimensions Infest of the following:(a)building to 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. 1 C <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. i 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSU D. a rn <br /> PLOT PLAN ��y�a�� oti � �tl <br /> J �G � o n <br /> � To C2 �Y FY� III TO <br /> Nol--JV I-S Ccn <br /> 1 <br /> rl <br /> e7RG,,r<S/� <br /> O I I` <br /> Iv <br /> ase BIG j <br /> 4U05t o.x,t /r�. <br /> i <br /> G'/ 2 to oil x <br /> �,N I� Tb .$ i�QQ f'Jt�hC a '� �cwry+ _. 31 <br /> In <br /> CONDITIONS OF PER <br /> 1. DRIVEWAY MUST METEDRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT SSUANCE. �. <br /> c � Z 2133 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. —N` rn <br /> 3, NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r" Q m0 <br /> i <br /> Q �EE C <br /> ' 4 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> all i forma- �+ <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of m m <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize that thi infor- $ O p <br /> mation I am providing will be rolled upon by the County of Burnett Wisconsin in determining whether to Issue a pormil. I ; $ $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing in his ap. ' <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person'o have <br /> access to the above da abed promi any reasonable time for the purpose of Inspection. T <br /> w <br /> SIGN HERE <br /> (sl re of owner or building contractor) r, �I ) ---, <br /> ZONING ADMINISTRATOR `E i $ ' i <br /> w wM N,Iw� T <br /> TOWNSHIP PERMITS MAY BE REQUIRED o ' lX 15 N m <br /> 8888881818 vmi <br />