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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ' o 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 w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the A C <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. N d <br /> r O <br /> OWNER R-P�1 �� I(, TELEPHONE <br /> ..11JJll <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME I <br /> I <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o -� <br /> n <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION0. <br /> 0 <br /> J <br /> STRUCTURE/ADDITION USE: Io <br /> v <br /> (Home/Cabin; Commercial Business; Bedroom;Deck; etc.) Z o <br /> o a <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). <br /> 2. Show the location of the well (W),septic tank (ST), and drainffeld (DF), o <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. Q o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSfrE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on a c <br /> 71 Z v <br /> PLOT PLAN o a <br /> m g� <br /> kach-ed <br /> N <br /> I I ~ <br /> O <br /> \/ J <br /> N <br /> O . <br /> J <br /> p <br /> v � <br /> Z <br /> I�1 <br /> mO, a M. N 0 off.: 'O <br /> m -$� J- am aeM <br /> CONDITIONS OF PERMIT: c m_. 'z C Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. a T'z i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. : <br /> 32 m <br /> -�, <br /> bi aBE ? D <br /> 1 declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowl- 'f: 2i m C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- o E O <br /> mation I 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 H <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have N v <br /> access to the above described premises at any reasonable time for the purpose of inspection. r 3 0 <br /> p m A N <br /> SIGN HERE `^` .8 [ <br /> (signat"u're�o�f,.4wner oorr building contractor) (date) o s <br /> ZONING ADMINISTRATOR <br /> NN W N N N <br /> m <br /> TOWNSHIP PERMITS MAY BE REOUIRED o 10 u v, o O <br /> 00000 $ 0 <br />