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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator w m 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 .2 U v <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the require <br /> mems 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. N m <br /> w <br /> C <br /> m <br /> TELEPHONEY6 6 <br /> n FO <br /> m A <br /> ADDRESS 71,A2 <br /> ^ m i <br /> EMERGENCY/FIRE NUMBER a / ROADNAME <br /> LEGAL DESCRIPTION (seetaxreceipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a <br /> N <br /> STRUCTURE/ADDITION USE: //z - �,e�,Q4.-x...� YR <br /> g o <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) v <br /> 2 0 <br /> o � <br /> N <br /> 1 <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 drainfield (DF). o <br /> 3. Show dimensions infest of thefollowing:(a) building to all lot lines,(b)buildingto center line of road,(c)building <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 <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I 3 m <br /> PLOT PLAN Z <br /> e <br /> fn <br /> ar <br /> bio <br /> o <br /> N <br /> O V y1.y W <br /> b <br /> 69c) y <br /> f � <br /> � z <br /> c — <br /> f <br /> a: v <br /> CONDITIONS OF PERMIT: o mc r� 0 <br /> .- <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m c; . g Z <br /> E �y <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 0 : ' - : S <br /> 1 NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �+r : m <br /> $ nff ; : O <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- ^: <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- \m <br /> motion 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o <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 officials charged with administering county ordinances or other authorized person to have 0, o <br /> access to the above described premises ata reasonable time for the purpose of inspection. m b <br /> N 9 A N <br /> SIGN HERE �7- <br /> o : <br /> (signal a owner or n ontractor) (date) H <br /> ZONING ADMINISTRATOR <br /> M <br /> TOWNSHIP PERMITS MAY BE REQUIRED m <br /> J00000000rn <br /> fA <br />