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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U) 0 o 0 <br /> APPLICATION FOR - LAND USE - PERMITS3. <br /> N O <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes 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 <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n C <br /> regulations of the State of Wisconsin. <br /> N � <br /> OWNER t TELEPHONE O <br /> R" l c r��c w <br /> ADDRESS L13 <br /> qS 5 <br /> EMERGENCY/FIRE NUMBER '), ROAD ROAD NAMEPitt ✓ L� <br /> LEGAL DESCRIPTION (see tax receipt) 6� / p <br /> ,C� J �/ �> 3% Q, 'YT's ., <br /> CONTRACTOR L�i r� <br /> TYPE OF PERMIT(S): !DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION o —1 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> J <br /> STRUCTURE/ADDITION USE' sc��/"Or-c-- <br /> (Home/Cabin;CommercialBoom; Deck;etc.) 2 o <br /> 0 0 <br /> a <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). l� <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). 5 �` <br /> 3. Show dimensions infeet of thefollowing:(a) building to all lot lines,(b)building to center line of road,(c)building <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 9 <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 m <br /> 11 Z `Q <br /> PLOT PLAN_ 0 a <br /> _--- c 9 <br /> fA i i <br /> CS <br /> t� w <br /> 8° <br /> O <br /> J <br /> J <br /> _ L <br /> it <br /> z <br /> [d <br /> ?(0 0 ( / WV 1 �' _ 9 �n rn m fn r D D O <br /> zaw - M <br /> � —g� am c = y <br /> CONDITIONS OF PERMIT: <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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N - 2 � m <br /> 0 : id O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my know) 2i m <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 P : m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- i O : p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 0 0 <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 t ermit county officials charged with administering county ordinances or other authorized person to have O N, <br /> access to the abov scribed premises at any reasonable time for the purpose of inspection. 3 0 m <br /> m : 0` <br /> A <br /> O <br /> SIGN HERE <br /> (sIat re of ow ilding contractor) (date; ' ro <br /> o : x: <br /> ZONING ADMINISTRATOR g <br /> ,��NN4rNN�� <br /> TOWNSHIP PERMITS MAY BE REQUIRED m0 0 0 0 0 0 o 0 o rn <br /> 000000000 <br />