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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m ' c c <br /> APPLICATION FOR - LAND USE - PERMITS 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work des <br /> cribed and m <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 a <br /> regulations of the State of Wisconsin. o <br /> w m <br /> w � <br /> c <br /> OWN TELEPHONE n £ <br /> m m <br /> ADDRESS m <br /> EMERGENCY/FIRE NUMBER ROAD NAME \ <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p 4 <br /> o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o` <br /> STRUCTLRE/ADDITION USE: a o <br /> 1 (Home/Ca Commercial Busine s;Bedroom;Deck;etc.l_ Z T <br /> 5Od v 0 9 <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). i <br /> 2. Show the location of the well (W), septic tank (ST), and dreinfield (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 C <br /> measurement to the ordinary high water mark of lake,stream,or river. O <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. O o <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a y <br /> PLOT PLAN Z <br /> E>livG�n <br /> -. C <br /> 1V r �I <br /> o <br /> o <br /> w <br /> i <br /> t D o c m m o D <br /> m <br /> a <br /> CONDITIONS R : 01 C o s <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o E ? 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. I L7 O <br /> C <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 informa. w m v+ O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. 8 ' a <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 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 otticials ch ed with administering county ordinances or other authorized person to have o <br /> access to th ove described premi es at Iny astriable timp for the purpose of inspection. m 8 $ <br /> T P E U m <br /> SIGN H <br /> w . a <br /> (si a re of o or building contractor) (date) <br /> ZONING ADMINISTRATOR 8 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> ut u, utornoo , m <br /> 88888888 vi <br />