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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Admir letrator u m f a <br /> APPLICATION FOR — LAND USE — PERMITS m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work desci ibed and m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Lard Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and _ <br /> regulations of the State of Wisconsin. w m <br /> m = f1 <br /> OWNER W f0 TELEPHONE n £ <br /> ADDRESS <br /> Is <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) �) <br /> CONTRACTOR M <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ` p <br /> SANITARY PRIVYo FILLING/GRADING CAMPING UNIT SUBDIVISION a = <br /> '^ r <br /> STRUCTURE/ADDITION USE: o ° <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z <br /> o ° <br /> 0 <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 No h (N). <br /> 2. Show the location of the well (W),septic tank (ST),and dreinfield (DF). 0 <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c I building .1 <br /> measurement to the ordinary high water mark of lake,stream, or river. � <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be of ned and 2 �(�" <br /> dated by the owner. fj o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I 3 rn <br /> PLOT PLAN o n <br /> o <br /> C ' <br /> M <br /> ,I <br /> cn <br /> � I <br /> 0 <br /> n <br /> O y <br /> N <br /> Z <br /> ) <br /> m � <br /> o —i€� '•a m m <br /> CONDITIONS OF PERMIT: o 3:: ,fi c g <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z o z 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. o y' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. , 3 �" ' O$ : p <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my know]- 1 oi , l i ; C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of sill informs- m <br /> tion contained In this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- il G <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue Ipermit. I O? 81 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providingin this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have o <br /> access to the above described premises at any reasonable time for the purpose of inspection. ' ; m <br /> SIGN HERE <br /> a <br /> (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP MITS MA BE REQUIRED r « N N 8 m <br /> Pig HHgg om <br />