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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d _ o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <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 <br /> regulations of the State of Wisconsin. w o <br /> c �? <br /> �'1 n O <br /> OWNER rn �9/ TELEPHONE o <br /> f/'lam V <br /> ADDRESS :2 /u// / <br /> V� <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) 1 V <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n L7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> 0 <br /> STRUCTURE/ADDITION USE: ° a <br /> v <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) 0 o <br /> o a <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 (M),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions in feet of thefollowing:(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 <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on o u, <br /> PLOT PLAN0/ Q <br /> A o'` n <br /> W y <br /> m � ° <br /> M <br /> m <br /> n <br /> 0 <br /> N <br /> J V\Y <br /> ° <br /> V) <br /> l7 y <br /> N <br /> ° <br /> I <br /> 3) <br /> C C S w 9 a 0 a: M <br /> m i£� � m em M <br /> < - N <br /> CONDITIONS OF PERMIT: o < _.: •2 g ro <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o £ _Q <br /> 21 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o C i rn <br /> o ; a� <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> Ri im C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- .n y.n m <br /> lion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. "ri a <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 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. I agree to permit county officials charged with administering county ordinances or other authorized person to have O N p <br /> access to the above described premises at any reasonable time for the purpose of inspection. r 3 o 0 <br /> m A N <br /> w w g <br /> SIGN HERE .8 [ E <br /> (signature of owner orbuilding contractor) (date) <br /> _ op <br /> ZONING ADMINISTRATOR ` g <br /> �H T <br /> TOWNSHIP PERMI MAY BE REOUIRED N m <br /> o 0 0 o b b m <br /> 0 0 0 0 0 o N <br />