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- . . on coymp. <br /> Bwnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m m o 0 <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 m c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the $ IT <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. Z <br /> b O <br /> OWNER � �, TELEPHONEo � <br /> l� <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> I � <br /> LEGAL DESCRIPTION (see tax receipt) V <br /> CONTRACTOR <br /> n <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION µ o <br /> n f7 <br /> SANITARY1 <br /> PRIVY FILLING RADING CAMPING UNIT^ SUB VISION o o <br /> T <br /> STRUCTURE/ADDITION USE: \ COW, <br /> �I Y_4 Illi 4Z-1c.{ - o °— <br /> (Home/Cabin;Comma al Business;Bedroom; ck;etc.) z o <br /> P o <br /> m <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). W <br /> 2. Show the location of the well (W),septic tank (ST), and dreinfield (DF). <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. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. IN v y� <br /> PLOT PLAN ° <br /> la w <br /> 0 <br /> w G, <br /> V, l <br /> � u) <br /> m <br /> g 9 <br /> • CONDITIONS OF PERMIT: < �'' Z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. p ! i :h ° 33 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 9 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ' r" ' '• X ` m <br /> i <br /> 1 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best o1 my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of�s11 informs- E «m ; m <br /> tion contained in this application(including any accompanying schedule)and 1 further declare that I recognize thgat this infor- 8 g ; p <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue'a permit. 1 $� 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providin in this ap. . <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized pe n to have p <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> 'n <br /> m o <br /> SIGN HERE w <br /> (signature of owner o bull Ing t (date) <br /> ZONING ADMINISTRATOR ` 8 <br /> M a riam� T <br /> TOWNSHIP ERMITS MAY BE REQUIRED o ' 4) 'J' 'a' A S m <br /> 88818888 UP <br />