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Burnett.County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o a <br /> APPLICATION FOR - LAND USE - PERMITS 3 _TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 5 <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 n <br /> regulations of the State of Wisconsin. y o <br /> w � <br /> 1 a O <br /> OWNER /� P TELEPHONE ���-/f— yL,� a F <br /> ADDRESS S t � <br /> EMERGENCY/FIRE NUMBER 1 ROAD NAME <br /> 1 <br /> LEGAL DESCRIPTION (see tax receipt) D <br /> CONTRACTOR N Cil�l I <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> m O <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> o < <br /> STRUCTURE/ADDITION USE: o 0 <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) m <br /> 2 o ee <br /> ° D T <br /> 7 <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 dralnfleld (DF). o <br /> 3. Show dimensions infeet of thefollowing:(a)building to all lot lines,(b)buildingto center line of road,(c)building q <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 o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I 3 <n <br /> PLOT PLAN z <br /> v <br /> A o n <br /> l <br /> 0 <br /> 0) <br /> I <br /> N <br /> O <br /> 0 <br /> 70 <br /> 7 <br /> O � <br /> N <br /> Z <br /> G <br /> m iic �mrn a :E <br /> amm <br /> CONDITIONS OF PERMIT: v m Z : c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o E L-A0 �� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =m 9 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. - m <br /> Cu- 0 : o <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o': C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- `n y(n m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 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.I agree to permit county officials charged with administering county ordinances or other authorized person to have N ` <br /> C) o [ <br /> access to the above described premises at any reasonable time for the purpose of inspection. mom <br /> a A W <br /> m m o : <br /> SIGN HERE . .n ` <br /> (signature of owner or building contractor) (date) 8 s o sE <br /> ZONING ADMINISTRATOR qa[�j <br /> Z': <br /> TOWNSHIP PERMITS MAY BE REOUIREDO N ti N m m 8 N m <br />