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on cimp <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U - o 0 <br /> '- 3 ? <br /> APPLICATION FOR - LAND USE - PERMITS v <br /> TO THE ZONING ADMINISTRATOR:The here undersigned g by makes application for a Permit for the work described and m c <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. H ° <br /> OWNER TELEPHONE O <br /> ADDRESS <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 p <br /> I \ <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° U� <br /> s <br /> STRUCTURE/ADDITION USE: 0 <br /> o — <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) ZO \ <br /> o ° <br /> D <br /> N <br /> } <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). <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 <br /> dated by the owner. 0 a <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a m <br /> c <br /> PLOT PLAN n o a <br /> M o <br /> C I <br /> �! m r <br /> I� <br /> n m <br /> XI <br /> Y/ ° <br /> N �J <br /> d v�f <br /> /0 &/Ovl <br /> G <br /> J :b <br /> /A y <br /> D <br /> m i� �maaFma M mm — g ' a@ & <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F '�*.� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. y: >7 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o ' i in <br /> in <br /> PP (including Yaccompanying Y y <br /> I declare that this application mcludin an schedule)has been examined b me and to the best of m knowlo <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs. " a ro«r m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- b" ig o p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o� 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 I. O N o <br /> access to the above described premises at any reasonable time for the Purpose of inspection. 'oo � <br /> SIGN HERE �i " o <br /> (signature of <br /> N <br /> of owner <br /> �or-building contractor) (date) <br /> ZONING ADMINISTRATOR ' 1m rl-ll fLiao � ol <br /> i i ? 81i i E <br /> MHH6) NM 't <br /> TOWNSHIP PERMITS MAY BE REQUIRED o ° N m <br /> 000g10 og f/) <br /> 1 <br />