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Bumett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U�y 1� a <br /> APPLICATION FOR - LAND USE - PERMITS 3. <br /> m ° <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and c a <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 <br /> regulations of the State of Wisconsin. w o v' 1 <br /> __ at <br /> OWNER / r TELEPHONE <br /> n O <br /> ADDRESS a(V3 C 7 6 1-16 ,e <br /> EMERGENCY/FIRE NUMBER �Q 14/3 ROAD NAME COU/U/1 , rk Ukk 6 O <br /> LEGAL DESCRIPTION (see tax rece <br /> ipt) <br /> � 7 3!J / / 1 �C�J�� Q5 0 <br /> I T ' 77 7 W U <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGEJACCESSORY STRUCTURE ADDITION p <br /> I <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> STRUCTURE/ADDITION USE: o °— <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z 1, <br /> O ° 1 <br /> a <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). <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building -4 <br /> measurement to the ordinary high water mark of lake,stream,or river. p ` <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and - \N <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 a m <br /> c <br /> PLOT PLAN o n <br /> m N <br /> 0 <br /> OA <br /> III <br /> 0 <br /> p <br /> ar <br /> o <br /> I <br /> Z <br /> Com. <br /> m iic��r Daoy <br /> m g� a� am m <br /> 33 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 0 -li � - <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =y: i M <br /> 3, NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ? i m <br /> ob a °: aE ' <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. o'; : m • i Fa <br /> C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- .w y p <br /> 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 <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 /> access to the above described premises at any reasonable time for the purpose of inspection. Soo m <br /> 'm <br /> SIGN HERE <br /> si at re of own wilding contractor) 1d51M 0 <br /> i o : <br /> ZONING ADMINISTR OR S <br /> TOWNSHIP PERMITS MAY BE REQUIRED o N N N N m <br /> 00000goo rm/1 <br /> e_. <br /> i <br />