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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS3' <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m <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 <br /> regulations of the State of Wisconsin. w m <br /> m <br /> / Q m h O <br /> OWNER TELEPHONE S(p �j- U 76C3 �O <br /> "''TTTT••••`""'"`���`�'"' D o <br /> G CQ m <br /> ADDRESS 1 a r/ 1�!'S fn 1.J d- <br /> 7 ru 1-0 <br /> EMERGENCY/FIRE NUMBER ( glf ROAD NAME Co-.n H•FvS f:r NS.p '�/�+ <br /> LEGAL DESCRIPTION (see tax receipt) A !��^T w S—a T—39 �� �p (,(,/ i.,, \ rb <br /> CONTRACTOR / <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> O <br /> SANITARY�_ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> ° <br /> ,n r- <br /> o_ <br /> STRUCTURE/ADDITION USE: ° <br /> v <br /> o abin;Commercial Business;Bedroom; Deck;etc.) 0 0 <br /> 0 <br /> 7 <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). DO <br /> 2. Show the location of the well (W),septic tank (ST),and drainfleld (DF). r` ° <br /> 3. Show dimensions in feet ofthefollowing:(a)building to all lot lines,(b)buildingto center line of road,(c)building , r^ <br /> measurement to the ordinary high water mark of lake,stream, or river. r 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and ' <br /> dated by the owner. Q o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. <br /> 71 z `v <br /> a <br /> PLOT PLAN o < <br /> C) �. <br /> ° <br /> 0 <br /> N <br /> ° <br /> O � <br /> W <br /> Z <br /> c 1. a* m <br /> g� = agQm M <br /> CONDITIONS OF PERMIT: < _': 'z <br /> I. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. p £ 5 -'Z <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. bi B O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- A : i m L <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- �^m n m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I 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. 1 $`� $ <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� p; <br /> access to the above described premises at any reasonable time for the purpose of inspection. r ; 3 0 <br /> 0 A N <br /> M � O <br /> SIGN HERE <br /> (date) <br /> (signature of own r or building contractor) <br /> ZONING ADMINISTRATOR + = <br /> �`nw(n 6s`nw(nT <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N N N m <br /> 0000 0bo oCn <br />