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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 /> o <br /> TO THE'ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described 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 Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and 3 Q. <br /> regulations of the State of Wisconsin. H m <br /> m <br /> C O <br /> OWNER// TELEPHONE <br /> y I m <br /> ADDRESS �J m <br /> EMERGENCY/FIRE NUMBER ' O'q / ROAD NAME , <br /> LEGAL DESCRIPTION (see tax receipt) c�j f' �] [�S�h vU� Ll /5y <br /> fX � <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION_ o <br /> o O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> 0 <br /> STRUCTURE/ADDITION USE: <br /> 3 Si S0ti 114 x ay o r <br /> (Home/Cabin;Commercial Business;Bedroom;Peck;etc.) Z o <br /> O 9 <br /> 3 <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). I o <br /> 3. Show dimensions in feet of the following:(a)buildingto all lot lines,(b)building to center line of road,(c)building -4 <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 signed and <br /> dated by the owner. <br /> 00 <br /> NOTE, BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a m <br /> 1I `v <br /> PLOT PLAN _ v�__�- � Zo a <br /> L s `1Nc fn o <br /> ,5ee C <br /> i <br /> Ile <br /> �9 YJI <br /> 0 s <br /> oe <br /> Z <br /> CONDITIONS OF PERMIT $ ' 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REOUIREMEN .�WITHIN 60 DAYS OF PERMIT ISSUANCE. o F o E T42 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION I RESTRICTED ALONG SHORELINE. = m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �' I m 2 ' OC <br /> a , <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m m m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- fn m Fn <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I 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 thisN <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> 38 � <br /> 0 A N <br /> N 8 <br /> SIGN HERE n r-? m <br /> fn a <br /> (signaturiii of owner or b 'ding contractor) <br /> 61 <br /> o : <br /> ZONING ADMINISTRATOR $ ' <br /> TOWNSHIP PERMITS MAY BE REQUIRED 8 N isT <br /> NN � N - -� <br /> 1 rnfnorn . m <br /> 8888888rmn <br />