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Office of Zoning Administrator m E <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 fi m 3 ' <br /> APPLICATION FOR — LAND USE — PERMITS <br /> g by application for a Permit for the work described an <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes app and <br /> _ <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 m <br /> c o <br /> I� <br /> OWNER SQ �� ` (Y c J hL�e W TELEPHONE O <br /> m <br /> ADDRESS fry N r <br /> EMERGENCY/FIRE NUMBER ROAD NAME LL <br /> LEGAL DESCRIPTION (see tax receipt) <br /> , <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> \X/ <br /> SUBDIVISION o <br /> PRIVY FILLNG/GRADING CAMPING UNIT <br /> SANITARY r. <br /> r <br /> a o <br /> STRUCTURE/ADDITION USE: v <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) 0 o <br /> 0 v <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 (NEI) and Indicate North (N). <br /> 2. Show the location of the well (N),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. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 O <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. Z v <br /> M o a <br /> PLOT PLAN CC o <br /> C , <br /> Au,t)(b( N <br /> M <br /> rRj <br /> Ch <br /> �r lel f <br /> 0 <br /> o <br /> o' <br /> v � <br /> C <br /> z <br /> f <br /> g 2. <br /> e <br /> CONDITIONS OF PERMIT: o f �`z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN GO DAYS OF PERMIT ISSUANCE. rn? <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Z+? S <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. E i i <br /> 1 declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowl- g <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs o< <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor 8 8 <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 /> har <br /> d with <br /> accesis tolthe rabove describedto permit premises atty officials anyreasonable tfimefor the tpurpose of inspection. <br /> other authorized parson to have <br /> a <br /> q: <br /> SIGN HERE (date) rr�� <br /> (signature of owner or building contractor) 25 <br /> 8 <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED ? N "MIN 9 <br /> 8888888'8 <br />