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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator Um o 0 <br /> APPLICATION FOR — LAND USE — PERMITS3 <br /> m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <br /> m c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m 00 <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3. n --:,3 <br /> regulations of the State of Wisconsin. / D /��_ /�,�, - <br /> r { L(r C J n o <br /> OWNER . TELEPHONE E <br /> �Ir�r�be�i�Trr>�,' � fat2� o <br /> ADDRESS m <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p W <br /> I <br /> n L7 n <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a -, <br /> STRUCTURE/ADDITION USE* o ° <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z <br /> ° ° <br /> a <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). <br /> 2. Show the location of the well (W), septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions in feet of the following:(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. O a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on a N <br /> c <br /> PLOT PLAN o a <br /> A,q3- csrn m ° <br /> V 3-5 a <br /> N <br /> O <br /> 73—� <br /> f <br /> (j)-0 to r DDO -a <br /> > > BaFm <br /> CONDITIONS OF PERMIT: 'o < Q C8 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o ai O : 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. F = =N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. T : a I m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- ao <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- " 0 o: m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I b� o <br /> further accept all liability which may be a result of the County of Burnett relying on this information I aproviding in this ap- o o <br /> m <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized person to have ct o <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 EE11 n <br /> m <br /> M N O <br /> SIGN HERE ? <br /> (signature of owner or building contractor) (date) <br /> of �E i <br /> ZONING ADMINISTRATOR <br /> N N W N N <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> N m <br /> U N N u u O m <br /> 000000000 <br />