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Burnett County 7410 Co. Rd. K, No. 102, Siren, W154872 Office of Zoning Administrator d m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS3. <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and R <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the M m l� <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 0. <br /> regulations of the State of Wisconsin. <br /> m m O <br /> OWNER I lr (� TELEPHONE o <br /> ADDRESS <br /> I� I,N <br /> n O <br /> EMERGENCY/FIRE NUMBER :�i'1 L� J ROAD NAME <br /> r _ <br /> LEGAL DESCRIPTION (see tax receipt) ql <br /> CONTRACTOR d' <br /> 1 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> 0 <br /> N = <br /> STRUCTURE/ADDITION USE: �c'3:'7Q o <br /> (Home/Cabin;Commercial Businea 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 North (N). <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (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)building -q <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. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a to <br /> c <br /> PLOT PLAN Z Q <br /> Ap a <br /> m N <br /> y_) a <br /> C ' <br /> s <br /> o <br /> N <br /> 2 <br /> G <br /> c= i 8P. n f m <br /> CONDITIONS OF PERMIT: S.: Q C$ =ro T+ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. p f '0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N ]7 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o 6 2 i m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy Of all informa- I «+a H m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- B g ; p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 1l 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 o <br /> access to the above described premises at any reasonable time for the purpose of inspection- 3 0 <br /> N m A N <br /> o <br /> SIGN HER q,F y /-3 <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR /I f�1L '1 i E of t <br /> J N N W N N N N <br /> TOWNSHIP PERMITS MAY BE REQUIRED o u u m v v O In <br /> 0000000o u)) <br />