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Office of Zoning Administrator d ; o 0 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 9 3 <br /> APPLICATION FOR — LAND USE — PERMITS m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 3 n <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and _ o <br /> regulations of the State of Wisconsin. m <br /> L /: 3 A7--`l�7� n <br /> OWNER ULT TELEPHONE <br /> ADDRESS <br /> o '� <br /> rn <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 a �� <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ^ <br /> �\ �"— <br /> '� r <br /> /� n , o ° <br /> STRUCTURE/ADDITION USE: l-'�'1v <br /> (Home/Cabin;C mmercial Business;Bedroom; Deck;etc.) Z o <br /> o c +. <br /> ( j <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). Y <br /> 2. Show the location of the well (W),septic tank (ST), 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 <br /> measurement to the ordinary high water mark of lake,stream,or river. J' <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 <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. Z a <br /> p n <br /> PLOT PLAN M o <br /> Q� ev- <br /> l N <br /> m <br /> n <br /> 0 <br /> m <br /> o <br /> N_ 1 <br /> Z <br /> 7D <br /> c r D a 0 <br /> CONDITIONS OF PERMIT: o f �.z <br /> I, DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. it So: <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 6 2 : m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> k <br /> 8 $� C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to best of my knows- : R <br /> edge and belief it is true,correct and complete.I acknowledge t <br /> hat I am responsible for the detail and accuracy of all Informs- <br /> edge <br /> nforms B g . <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 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. <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 c o <br /> access to the above described premises at any reasonable time for the purpose of inspection. T . 3 0 ' <br /> m V A N <br /> SIGN HERE <br /> (signature of owner or budding contractor) (dhte) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED N 8 <br /> 8 '0808 8Ot <br />