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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI SU72 Office of Zoning Administrator 0 ' <br /> APPLICATION FOR - LAND USE - PERMITS - . <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q u 0 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <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. - o <br /> Nal <br /> G <br /> C O <br /> m <br /> OWNERu(- TELEPHONE AB9— J` n £ <br /> O _ <br /> ADDRESSy OtC`�T'Yl <br /> u I C71�� V�LL <br /> EMERGENCY/FIRE NUMBER ROAD NAME n <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR ✓-7//CC,. q l r-,V/ (4/)I/ V <br /> TYPE OF PERMIT(S): DWELLING/BUILDING lRA1GE/ACCESSORY STRUCTURE ADDITION <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION /t r^ o <br /> o < <br /> N <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) v <br /> Z O W <br /> o c <br /> m <br /> 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 drainfleld (DF). 5 <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)buildingto center line of road,(c)building <br /> measurement to the ordinary high water mark of take,stream,or river. s� <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 0 <br /> dated by the owner. 0 c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. <br /> PLOT PLAN 1A Z <br /> o <br /> o 0 <br /> c C i <br /> g <br /> , o <br /> DGJ <br /> f3 O <br /> _ <br /> O <br /> = <br /> b <br /> O ti <br /> N I� <br /> Z <br /> G <br /> 9m <br /> CONDITIONS OF PERMIT: c ?w: c. R. ll <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F5i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. t5 m <br /> C <br /> Pp (including Yaccompanying ) Y Y � �• <br /> 1 declare that this application Includin an schedule has been examined b me and to the best of m knowl- � <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- "' «a a <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 permi . `,3 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 <br /> ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have ; O o <br /> access to the above described premises at any reasonable time for the purpose of inspection. a <br /> m <br /> SIGN HERE ~ . m - <br /> (so at of owner or building contractor) (date) t}.( <br /> a <br /> ZONING ADMINISTRATORU,U1_j <br /> 8 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 888 $8888 vi <br />