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Burnett County-7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ,� m o OZ <br /> APPLICATION FOR — LAND USE — PERMITS 3_ <br /> 0 <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 <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. y <br /> m � <br /> OWNER .� ` ( "r�©^I TELEPHONE <br /> �� ✓/ n £ <br /> O � <br /> d � <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER �C)�� ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) /O 9. <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a ° <br /> abi� <br /> STRUCTURE/ADDITION USE: O/�� o ° <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) z <br /> o ° <br /> 0 <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 (Mf),septic tank (ST), and drainfield (DF). o <br /> 3. Show dimensions in feet of the following:(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. 0 jj <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. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSfTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. an 3 m <br /> Q <br /> PLOT N� <br /> I rn ° o <br /> w l� <br /> La.� i rl <br /> ©-i <br /> N <br /> O <br /> 2 <br /> O y <br /> z <br /> Ti,�-cam <br /> `vrn�U leo 4 - <br /> �r� lro <br /> �oS R55 La lir, c 9S� 2 aH = <br /> G Nt <br /> DITION IPERMII: —.-- -- - < m'( <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. ZP m 5': Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. E T to <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. .0 i ' O : m <br /> oE <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <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"w n T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B o <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I gq <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 ? O N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. m ` r Soo <br /> m A N <br /> SIGN HERE <br /> (sign tune of ow r bu g c nt Q t 8i <br /> ZONING ADMINISTRATOR <br /> NN N H T <br /> TO HIP PERMITS MAY BE REQUIRED o u u,N N u, m a m <br /> 0000go N <br />