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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ; m o . <br /> APPLICATION FOR - LAND USE - PERMITS f <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and H <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m 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. <br /> w � ` <br /> -PIn n Nelsa n <br /> OWNER � 1 TELEPHONE f <br /> ADDRESS V 3) `/' lip <br /> EMERGENCY/FIRE NUMBER ROAD NAME SU <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> cf <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo °< <br /> 0 - <br /> m � <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ZO <br /> o ° <br /> a <br /> m <br /> a <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 in feet ofthefollowing:(a) building to all lot lines,(b)buildingto 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. 3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 a <br /> c <br /> PLOT PLAN 0 a <br /> < p) I <br /> � P CSm <br /> m <br /> i - <br /> m <br /> ° <br /> 0 <br /> // o � <br /> �O)V lu�sow- I S A'vcLre o� �21Ss�b4! o <br /> / m ~ <br /> - <br /> 6 G,N <br /> lr �ll��'�i 1 I .S e✓U2S ♦ �i/" �e'�eS6pi. � � 1Ac� <br /> d f o"*j.,".. esgow <br /> > > amM <br /> m. Dg moN <br /> CONDITIONS OF PERMIT: <, m Z C o ,'o <br /> I. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F a +� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. = N m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �" I m g C <br /> $ a c <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl o m m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- I w m w 0 <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this in or . . . m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this a " <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have Oo p <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 $ o <br /> SIGN HERE ' w a <br /> (signature of owner or building contractor) (date) o s <br /> ZONING ADMINISTRATOR l i" ' <br /> TOWNSHIP PERMITS MAY BE REQUIREDm <br /> " <br /> N N O N 0 0 0 <br /> m <br /> 888899 $ $ rn <br />