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CA- (baup , <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 8 f o <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> ndw <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 <br /> regulations of the State of Wisconsin. w ro <br /> M a <br /> OWNER c I l ll lc� l 1 1 1�(-� TELEPHONE C £O <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR EII(fid — <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O <br /> ' <br /> o <br /> e <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o –� <br /> �^ r <br /> STRUCTURE/ADDITION USE: ° <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z a �� <br /> o c <br /> } <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). r <br /> 2. Show the location of the well (W),septic tank (ST), and dralnfield (DF). <br /> 3. Show dimensions Infest of the following:(a)bullding 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. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1A o <br /> Z v <br /> PLOT PLAN ° <br /> ni R� o I`� <br /> C 1 <br /> M ()) -Z <br /> C) I� <br /> 9 <br /> ( p W <br /> O <br /> m <br /> O � <br /> a / <br /> Il <br /> Z <br /> f <br /> CONDITIONS OF PERMIT: v' 2: Z C 8 g <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o E E E 1Q <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. `' r" Q X E <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowl. g <br /> ii <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informs- �+e <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- $ $ <br /> motion 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 <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 <br /> access to the above described promises at any reasonable time for the purpose of Inspection. r <br /> �i <br /> w <br /> SIGN HERE '• •"' ' <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> �s e.Ywi�w i� <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> ri8 <br /> 88888',88 <br />