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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d c c <br /> APPLICATION FOR - LAND USE - PERMITS 3. <br /> TO THiE ZONING ADMINISTRATOR:The undersigned here makes m o <br /> g by application for a Permit for the work described and � io <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 /> m A <br /> C <br /> TELEPHONE n £ <br /> y��Q A �t✓ J i� �PY F�?e/—. O m <br /> [ m <br /> ADDRESS ��% �, h�. <br /> J <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) ! / <br /> .l-e I�S <br /> CONTRACTOR i / - <br /> n <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> ,C �^ r <br /> STRUCTURE/ADDITION USE: /,.`" 0 r o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z � <br /> 0 0 <br /> v <br /> DIRECTIONS FOR PLOT PLAN DRAWING; (Aerial or top view) IO <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). 0 <br /> 2. Show the location of the well (W),septic tank (STI,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 r� <br /> measurement to the ordinary high water mark of lake,stream,or river. I" 1 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and X <br /> dated by the owner. O o <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. an 3 rn <br /> c <br /> PLOT PLAN o <br /> C a "\ <br /> M <br /> 5 <br /> t <br /> d <br /> m <br /> N <br /> O <br /> O <br /> J <br /> b <br /> Q y <br /> N ^rv1{A\v\)1 <br /> 1� <br /> Z <br /> Z <br /> G <br /> 0m (� N r ➢ D <br /> In <br /> M �� > ¢ In <br /> M <br /> CONDITIONS OF PERMIT: c < Zvi. : ,z m o 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 5 M. i i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ ^' I m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ' m " C <br /> n � ; <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 Fw m er <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 m $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this a <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have u, o <br /> access to the above described premises at any reasonable time for the purpose of inspection. m $ g <br /> M 3 A y <br /> SIGN HERE ✓ tZ(''r-lc.Ca - -n% 7 -�r '" '�j* «. : <br /> N <br /> (si lure of owner or uild' o ract `r ( ate) ; x <br /> ZONING ADMINISTRATOR <br /> TOWN I PERMITS MAY BE REQUIREDm <br /> NN Inoo � m <br />