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Burnett Cbunty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator g of 1 0 <br /> APPLICATION FOR - LAND USE - PERMITS 0 <br /> m ° <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m c <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 $ W <br /> regulations of the State of Wisconsin. u m <br /> c u <br /> I�� rold ( (na� r $ E <br /> OWNER A TELEPHONE <br /> ADDRESS �q3a Drew Ave Mo IaSebIP I l 5S4a, e <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> C <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> L1 (1 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o` < r`.•�. <br /> ��/- _ <br /> STRUCTUREJADDITION USE: < / r(,1Jy <br /> (Home/Cabi ;C(ommercial Busin ss;Bedroom; Deck;etc.) o 0 <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 (N),septic tank (ST),and drainfield (DIF). g <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building � I <br /> measurement to the ordinary high water mark of lake,stream, or river. 0 <br /> 4. H separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STAUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 o rn <br /> PLOT PLAN ° <br /> COI = <br /> A - <br /> 1 <br /> 1 � <br /> 0 <br /> _ <br /> ° < <br /> _ <br /> All <br /> o <br /> O -1 <br /> M <br /> �1 <br /> h z <br /> 3 � <br /> _ m <br /> CONDITIONS OF PERMIT: C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. '• MM <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. G <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- }± # <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor• S S O <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue s permit. I $ $ E <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 <br /> access to the s described promises at any reasonable time for the purpose of Inspection. T . <br /> wi <br /> SIGN HERE See J <br /> ( gree ure of ow r b ding eonlractor) (date) <br /> i <br /> ZONING ADMINISTRATOR f ` 8 : '• <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 8U) <br />