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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ; m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS 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 ; 'J <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. o <br /> m m <br /> OWNER �� )��� ) I r--ND TELEPHONE <br /> 02ADDRESS <br /> EMERGENCY/FIRE NUMBER -- ROAD NAME"i-ner, <br /> LEGAL DESCRIPTION (see tax receipt) !" <br /> CONTRACTOR ) <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION o <br /> n L7 y� <br /> SANITARY A PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> 0 <br /> m r- <br /> STRUCTURE/ADDITION USE: o <br /> 0 <br /> v <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) 0 o <br /> o a <br /> m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) � <br /> } <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). °r <br /> 3. Show dimensions infest of thefollowing:(a) buildingto all lot lines,(b)buildingto centerline 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. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a m <br /> 71 Z Q <br /> PLOT PLAN A ° <br /> m y <br /> C ) <br /> I _ <br /> 0 <br /> o <br /> I`-YA <br /> N L <br /> n tl1 , I <br /> f <br /> M a 0 0 D f m <br /> am a. = M <br /> CONDITIONS OF PERMIT: v m 5.y;i c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 'z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =2 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. c n p <br /> o : a� C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 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- y o m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> B <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o o <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this so- d, <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have O m p <br /> access to the above described premises at any reasonable time for the purpose of Inspection. m 3 0 <br /> p A N <br /> ry m A . <br /> N o <br /> SIGN HERE <br /> (signature o (date)f owner or building contractor) o I <br /> ZONING ADMINISTRATOR �. � Im F ' (� � <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 o � o^ d <br /> M <br /> 0 000fA <br />