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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator N 9 -+ ''z <br /> 0) m ° 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 = <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and y <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <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. 'o <br /> N 0 <br /> n w <br /> OWNER f�� Y, p It <br /> J TELEPHONE n <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> ctrRd l <br /> LEGAL DESCRIPTION (see tax receipt) /- <br /> //}} .j b✓' y�SS ISS� 4 <br /> 3��'Y.l�/r: �1W t^ <br /> CONTRACTOR �/ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING C/ GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> m' <br /> SANITARY_ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> 0 <. <br /> J <br /> ,.�/ ^ r <br /> STRUCTURE/ADDITION USE: � / C/u '-- <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) Z <br /> o ° <br /> 9 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) pQ'� <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 (Sr),and drainfield (DF). I� <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. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 2 l! <br /> dated by the owner. 0 0 <br /> NOTE' BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 71 o y <br /> PLOT PLAN 0 ° <br /> AP n <br /> M o <br /> f ti'e u 11 a X e C ' <br /> m � <br /> I <br /> G <br /> i5� n <br /> 0 <br /> J <br /> O 4 <br /> J <br /> O � <br /> N <br /> UJ <br /> Z <br /> y <br /> � 0C 000c, M <br /> J J n , , <br /> m a' am <br /> CONDITIONS OF PERMITS v A < : m o 6 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. 0 4 T� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ » m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 8 : O c <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- . o I Am <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- �w m <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. 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. 1 agree to permit county officials charged with administering county ordinances or other authorized person to have �n p <br /> access to the above described premises at any reasonable time for the purpose of inspection. n _ 3 8 8 <br /> ` p O A m <br /> SIGN HERE C 4 <br /> N <br /> (sign i of wrier or b ilding contractor) (date) x <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REOUIRED S� 9`gg )"N 0 o o 9 m <br /> X88 8888rmn <br />