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V1 corny <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ,� ; a o <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> 0 <br /> TO THE ZONING ADMINISTRAT R:The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The un ersigned agrees that all work shall be done in accordance with the requirements of the q <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. <br /> 7'V o <br /> OWNER /p C TELEPHONE R <br /> o ' <br /> ADDRESS m <br /> i <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR (' <br /> TYPE OF PERMIT(S). DWELLING/B ILDING GARAGE/ACCESSORY STRUCTURE ADDITION o I �T <br /> o cT <br /> SANITARY_ PRIVY FILLING/GRADING CAMPING UNITSUBDIVISION o _ r' <br /> '^ r <br /> 0 <br /> STRUCTURE/ADDITION USE: ° <br /> v <br /> (I iome/Cabin;Commercial Business; Bedroom;Deck;etc.) °Z o <br /> a <br /> m <br /> } <br /> DIRECTIONS FOR PLOT PLANDRAWING: (Aerial or top view) I� <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). I� <br /> 2. Show the location of the we I (W),septic tank (ST), and drainfield (DF). <br /> J <br /> 3. Show dimensions infeet of th 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. Q <br /> 4. If separate plans are submitt d by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. 0o <br /> NOTE: BUILDING/STRUCTURE LOCA IONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a m <br /> 1I Z `v <br /> PLOT PLAN ° a <br /> m o <br /> C <br /> I- <br /> r <br /> � <br /> 0 <br /> 'yJ ' <br /> 2 <br /> J I� <br /> m O,C N r n a O <br /> 00a0c = M <br /> CONDITIONS OF PERMIT: <.in 'z T g .ro <br /> 1. DRIVEWAY MUST MEET D IVEWAV WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F - <br /> I <br /> 2. REMOVAL OR CUTTING O TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ` =2 w 9 <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o : ig o O <br /> I declare that this application(in luding any accompanying schedule)has been examined by me and to the best of my knowl- : o : i m B <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- «+m T <br /> tion contained in this applicatio (including any accompanying schedule)and I further declare that 1 recognize that this infor- r-a S p <br /> mation I am providing will be r lied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o� <br /> further accept all liability which nay be a result of the County of Burnett relying on this information I am providing in this ap- <br /> plication. I agree to permit coun y officials charged with administering county ordinances or other authorized person to have i i i O N v <br /> access to the above <br /> described iremises at any reasonable time for the purpose of inspection. � <br /> SIGN HERE OL <br /> into a of em— ba d"M-G0QiIMQW4 <br /> r , p <br /> apN <br /> N ; <br /> O : X <br /> ZONING ADMINISTRATOR i i i g i K <br /> TOWNSHIP PERMITS MAY BE REQUIRED o N N m <br /> 000�o'X $ <br /> $ N <br /> X <br /> X <br /> ert <br /> O <br />