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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator Wa a <br /> ,APPLICATION FOR — LAND USE — PERMITS 3 <br /> o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <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 3 n <br /> regulations of the State of Wisconsin. m <br /> w m <br /> (� a V O <br /> OWNER TELEPHONE ��— X O <br /> V <br /> m <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER � � J ROAD NAME C A <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PE MIT S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> I <br /> L7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> 0 <br /> J <br /> m r <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z <br /> o ° <br /> 9 <br /> _ N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) ` 1� <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). v \ <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions infeet of thefollowing:(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 signed and M <br /> dated by the owner. Q o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 91 o m <br /> c <br /> Z o <br /> PLOT PLAN A 0 a <br /> see- 007-- R- <br /> Mr o <br /> H I � I <br /> I <br /> C � <br /> N <br /> 8 <br /> 1)0 <br /> N Q <br /> O <br /> J <br /> J <br /> v � <br /> N <br /> I <br /> I y <br /> f <br /> c a r a 0 m <br /> M <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F S ;Z -I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - =N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Ste^ : O p <br /> g E �. <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- c : m g <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- «.m«.; m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that thisinfor- B g p <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o18 o <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing in this ap- .e <br /> plication.1 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 at any reasonable time for the purpose of inspection. r 3 Se <br /> m m n w <br /> m <br /> w m o <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) - <br /> ZONING ADMINISTRATOR `„ gi i <br /> j <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> I""0SSoN <br />