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Burnett.County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 5 : f o <br /> APPLICATION FOR - LAND USE - PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the $ <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. " R 1 <br /> OWNER I` (L� �O�'� TELEPHONE <br /> f ` o <br /> ADDRESSSSL110 (4bEMERGENCY/FIRE NUMBER ROAD NAME I <br /> 0 <br /> LEGAL DESCRIPTION (see tax receipt) ' J <br /> CONTRACTOR 0 <br /> v` <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION I O <br /> SANITARY PRIVY FILLINGIGRADING CAMPING UNIT SUBDIVISION o <br /> T o <br /> m r <br /> 0 o_ <br /> STRUCTURE/ADDITION USE: - /,1 <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) a <br /> m <br /> � L <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 No h (N). r <br /> 2. Show the location of the well (W),septic tank (ST),and dralnfield (DIF). ° <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c building 0 d� <br /> measurement to the ordinary high water mark of lake,stream,or river. <br /> 4. H separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and A <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I o rn <br /> Z c <br /> PLOT PLAN fD o ` I <br /> � L <br /> IIII�u1�b � I <br /> L <br /> �1 <br /> K, <br /> o <br /> 0 <br /> r <br /> m <br /> o <br /> Z <br /> S <br /> I <br /> m <br /> o $2: ZCis g' ; <br /> CONDITIONS OF PERMIT: o F E i Q - . <br /> i. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. I_N; '. Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ? rr <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> C <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- »�» i = <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy f all informs- C <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize l at this infor- <br /> mation I 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 provid ng in this ap- <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. „ m : )(- <br /> m <br /> SIGN HERE (date) <br /> ZONING ADMINISTRATOR gg I <br /> - <br /> TOWNSHIP PERMITS MAY BE REQUIRED 8 8 8 8 8 8 8 8 0 <br />