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Burnett County 7410 Co. Rd. K. No. 102, Siren, WI 54872 Office of Zoning Administrator v ( m ' ; <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m ° <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v a <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of and 0 $ <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and _ <br /> regulations the State of Wisconsin. w m <br /> J� O <br /> OWNER pQ '— TELEPHONE f(�6 _ p q <br /> ADDRESS �0 1 `� IJLI r v �� e 1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME 1 <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION, ! O <br /> n C) <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o < <br /> pec - ►� '� ao' <br /> N <br /> STRUCTURE/ADDITION USE: ° 7 <br /> v <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) o 0 <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 (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 <br /> measurement to the ordinary high water mark of lake,stream,or river. Q <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signs and <br /> dated by the owner. Q <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUl D. o N <br /> 40_ Z v <br /> PLOT PLAN O ° <br /> C I <br /> In <br /> chi C <br /> ff ( <br /> ° I�U <br /> d <br /> o � <br /> m <br /> Z <br /> mD <br /> L <br /> M <br /> CONDITIONS OF PERMIT: a g M <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c :JI vi i i 9 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ? . g m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. s S p <br /> Lr ` E C <br /> I declare that thin application(including any accompanying schedule)has been examined by me and to the best of my nowt- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all 1 forma• ' •w "` m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that ihi infor- O <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a rmil. Imo'; $ $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in is ap• <br /> plication.1 ogres to permit county officials charged with administering county ordinances or other authorized person�°have <br /> access to the above described promises at an reasonable time for the purpose of Ina ion. r <br /> i <br /> SIGN HER — N ~` ` <br /> (atgnature caner or btll I contractor) ) i <br /> ZONING ADMINISTRATOR <br /> wNw� w,N� T <br /> TOWNSNIP PERMITS MAY BE REQUIRED 2 o rn <br /> m <br /> 888888'',8'8 in <br />