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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d A; a <br /> APPLICATION FOR - LAND USE - PERMITS 3. <br /> m <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 m <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. w m 1 <br /> m � <br /> OWNER TELEPHONE o. <br /> ADDRESS /S9 Cf�^oL LN. Gh SI. aur m <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> ,, � <br /> ^ <br /> LEGAL DESCRIPTION ((sseetaxreceipt) LOT .Jb_A,1rav✓ x-/44I /�/uAN0P,- <br /> CONTRACTOR <br /> TYPE OF PERMIT(S)). DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n 0 <br /> SANITARYPRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o` <br /> 0 <br /> STRUCTURE/ADDITION USE: �i4�i/✓ o ° <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z v <br /> 0 0 e <br /> N <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). <br /> 3. Show dimensions infeet of the following:(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. <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 o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISS ED. 1I 3 W <br /> c <br /> PLOT PLAN i ' o n <br /> m 0 R. <br /> O <br /> al <br /> FrI <br /> �a�� <br /> 0 <br /> r o <br /> l�0 <br /> o <br /> m <br /> 50� I,/ ' s <br /> �7 <br /> CONDITIONS OF PERMIT: ��-, .2 o 0. 'o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F TQ y <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. = r^ m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m g 0 c <br /> a <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- i o 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 informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- u,m N <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I m $ <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- N <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have u, 0 <br /> access to the above described premises at y reasonable time for the purpose of inspection. 8 <br /> T A <br /> SIGN HERE a <br /> (signature of owner or building pdntra q <br /> ZONING ADMINISTRATOR — - ✓ <br /> I <br /> TOWNSH P PERMITS MAY BE REQUIRED AUG <br /> 888 88 8 <br />