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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator rn v i Z <br /> m £ o <br /> APPLICATION FOR - LAND USE - PERMITS 3. <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and y <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m 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. = o <br /> m <br /> c <br /> OWNER LflQGTELEPHONE o <br /> I�Iti! IJ O = <br /> ADDRESS_j5+_WyUTWCSe-off W1 <br /> S n I m � <br /> EMERGENCY/FIRE NUMBER ROAD NAME i <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR I lFr <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDrrION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> 0 <br /> _ <br /> r <br /> STRUCTURE/ADDITION USE: o ° 4 <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) Z 0 <br /> o ° <br /> O <br /> N <br /> 1 <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 in feet ofthefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building jlllr/`1�) <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 X <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '11I a N <br /> c <br /> PLOT PLAN o a r ^ <br /> C o <br /> AtTnoeo <br /> n <br /> 0 <br /> N y <br /> O <br /> Q � <br /> N <br /> Z ILS._ <br /> Z <br /> Ny r� <br /> O_ c d r n a 3 <br /> ° � g'� �a.0 QI= = 37 <br /> m <br /> In <br /> CONDITIONS OF PERMIT: N. � c 0 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o m 0 �Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <^ : G)� m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the bestof my knowl- mss' o .m: C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- " rn y p m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor. 'i a <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <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 o <br /> access to the above described premises at any reasonable time for the purpose of inspection. E 3 b "1 <br /> 0 3F <br /> M AAp N <br /> N O <br /> SIGN HERE <br /> (signatute of r orb g c tra <br /> 0O <br /> ZONING ADMINISTRATOR ) <br /> TO NSHIP PERMITS MAY BE REQUI T�� m <br /> S000 U) <br />