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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator <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 2 w <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 laws and 3 a <br /> regulations of the State of Wisconsin. H m 1 <br /> TELEPHONE 6 <br /> /7 �_6 O <br /> m m <br /> ADDRESS IJV .�Mo m <br /> EMERGENCY/FIRE NUMBER "� ! ') ROAD NAME <br /> ` II��CCIA����7�XX <br /> LEGAL DESCRIPTION (see tax receipt) /V I (yv f � !-S— / <br /> CONTRACTOR _ 1 ���""'tYY� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE �� ADDITION o n <br /> n L7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo 0 <br /> 3h�X � ' S " <br /> STRUCTURE/ADDITION USE: / ° <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z o <br /> o a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) I r <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). VJ <br /> 2. Show the location of the well (W),septic tank (ST),and dretnfield (OF). < <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building -q (� <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 o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSRE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on 3 N <br /> 11 Z Q <br /> PLOT PLAN y a <br /> N <br /> I N <br /> 1A �- <br /> li <br /> clo ° <br /> 0 <br /> o <br /> 1 <br /> Z <br /> a <br /> oofM <br /> n @: <br /> CONDITIONS OF PERMIT: <br /> 1, DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o E o 'z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. r= <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- ; o m C <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informs- m rn <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- is p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I `I3 <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.I agree to permit county officials charged with administering county ordinances or other authorized person to have N <br /> access to the above described premises at any reasonable time for the purpose of inspection. T 3 b <br /> m m <br /> m <br /> SIGN HERE <br /> (signs re of 4er or building contractor) (date) [ �, <br /> ZONING ADMINISTRATOR <br /> Nw us T <br /> ((�� <br /> TOWNSHIP PERMITS MAY BE REQUIRED O m uull N N N p 0 m <br /> 0000000o Vm) <br />