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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m : c c <br /> APPLICATION FOR — LAND USE — PERMITS m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work deal bed and a <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremer its of the $ �� <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the I aws and _ <br /> regulations of the State of Wisconsin. m <br /> w m <br /> c <br /> OWNER �-�-�zl� L � t €�lIVnPj -- 0TELEPHONE <br /> m <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER G l 4% ! ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) f� <br /> CONTRACTOR li <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION 12 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> / <br /> STRUCTURE/ADOITION USE: F,l/ <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z a <br /> a 0 <br /> a <br /> m <br /> 3 <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 Nort i (N). <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (D17. 5 <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. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sli Inetl and <br /> dated by the owner. <br /> 00 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE I ZUEO. 11 'o y <br /> C <br /> PLOT PLAN o 0 <br /> O <br /> C I <br /> I � <br /> 0 <br /> N <br /> J <br /> m <br /> O <br /> N <br /> TJ <br /> ( <br /> f <br /> m p,c or r G <br /> ITT <br /> CONDITIONS OF PERMIT: . S i Z C 8 g O Z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. e E �`z : 1 <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. i m <br /> I declare that this application(including an accompanyingschedule has been examined b me and to the best of knowl- ,E o: C <br /> aDD ( g Y 1 Y Y �E <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of a I informs. ' " N m N i <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that his infor- : : p <br /> matlon 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <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- i E ' <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have p <br /> access to the at described prepillses at an noble time for the purpose of inspection. <br /> SIGN HERE <br /> (signature cf wner or building contractor) (date) <br /> ZONING ADMINISTRATOR i $ : <br /> TOWNSHIP PER ITS MAY BE REQUIRED o g g m <br /> rn <br /> 888888880 <br />