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Burdett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o c <br /> APPLICATION FOR - LAND USE - PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes Q ° <br /> lg by application for a Permit for the work described and i+ <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m -� <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the la Ns and n <br /> regulations of the State of Wisconsin. <br /> m m _ <br /> m <br /> OWNER O { K TELEPHONE 0 O ° <br /> ADDRESS 3 / / O a Yr <br /> EMERGENCY/FIRE NUMBER Ca 8 ROAD NAME Ft C rn O <br /> Cts Llo _ <br /> LEGAL DESCRIPTION (see tax receipt) 1 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p �^ <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION — ° <br /> o <. <br /> I N <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) _ <br /> o ° <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 Infest 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 <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. 0 O <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BEUED. on 3 m <br /> PLOT PLAN n P Ei <br /> M .' T <br /> N )J <br /> / / MIiJ <br /> i <br /> r1 <br /> o J <br /> o � <br /> fp <br /> ° I�r <br /> z <br /> 7,J n <br /> f <br /> R fm <br /> v $z;: Sa31 <br /> CONDITIONS OF PERMIT: ,�Cm <br /> '� °o5. <br /> 3: <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 0 :il <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. i <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. v�. !" O i i Q <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of nny knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- i »m» T <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize that is infor- `. <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 i` $`� 8 E <br /> fuller accept all liability which may be a result of the County of Burnett relying on this information I am providing i i this ap- <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized person to have I` 0: 0: <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> � m <br /> SIGN HERE � —SAV ? » E <br /> (signature of owner or building contractor) (date) ' <br /> ZONING ADMINISTRATOR <br /> 8i <br /> TOWNSHIP PERMITS MAY BE REQUIRED NjO' MN a8888888 <br />