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Burnett Cuunty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator on 0�, <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. y d <br /> w � <br /> n O <br /> OWNER /f/ j TELEPHONE <br /> ADDRESS V�(�,1 ?J (�,�-{-s hIA. <br /> EMERGENCY/FIRE NUMBER �b tu_�'�b ROAD NAME-,p,,��LL <br /> LEGAL DESCRIPTION (see tax receipt) <br /> 1 <br /> CONTRACTOR Q <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> y' m <br /> SANITARY /` PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o o / <br /> STRUCTURE/ADDITION USE: °- <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z <br /> 0 o J <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) `n <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 (yi), septic tank (ST), and drainfield (DF). o <br /> 3. Show dimensions infeet ofthefollowing:(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. 0 <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. C e <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSFTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a y <br /> Z o <br /> PLOT PLAN M o n <br /> M j o <br /> C l o <br /> u <br /> M <br /> I <br /> 0 <br /> m <br /> o <br /> y 1 <br /> I�JJ <br /> Z <br /> a <br /> F <br /> A O,c �Nr0 of 'fl <br /> O 0D `G U C N O =. M <br /> CONDITIONS OF PERMIT: m Z ,� $ m �+ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o 0 �`z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 33 <br /> »; <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. _ o O�t c2i p <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- S a m«r m <br /> tion contained in this application(including any accompanyingschedule)and I further declare that I recognize that this infer- Bg : p <br /> mation I 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 ap- <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized person to have N m <br /> access to the above described premises at any reasonable time for the purpose of inspection. p nn <br /> W <br /> m O N <br /> SIGN HERE <br /> (signature of owner of building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> u wfnv n <br /> TOWNSHIP PERMITS MAY BE REQUIRED N m <br /> g '000N <br />