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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 o <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> 0 <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 m c <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. m <br /> m v <br /> 1 ` p \V' 1 ���� Q c O <br /> OWNER. \ NC QU, l '`�C C,rte\ .S(H\LEPHONE <br /> o m <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) n 1 <br /> CONTRACTOR \,AC� cA e—\ C <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION o �\ <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION c <br /> STRUCTURE/ADDITION USE: (� �� I V o = j26 C <br /> (Home/Cabin;Com rcial Business; Bedroom; Deck;etc.) Z <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> } l <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 (DIF). <br /> 3. Show dimensions in feet of the following:(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. Q <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. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on a w <br /> c <br /> PLOT PLAN o a <br /> fn <br /> m <br /> a y <br /> 7 <br /> N <br /> 0 <br /> m D <br /> CONDITIONS OF PERMIT: < Z C o 3 <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F „� a <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ v m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. (+ ro C <br /> a � <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m 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- w m as <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 8 '? 8 <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 OV p <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 8 2 <br /> In v A m <br /> iD m A <br /> SIGN HERE <br /> (sig ture of_o�nerorbuildin contractor) (date) o ' s <br /> ZONING ADMINISTRATOR 11-4 <br /> I O'ITL/,VI 8 p <br /> T . <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> u, fnou, 00m,`b' <br /> ggggggggN <br />