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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 5 : f c <br /> APPLICATION FOR — LAND USE — PERMITS . _ <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work dewribad and v m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirementof the c— <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. m <br /> _ w � <br /> OWNER TELEPHONE ? E <br /> J O m <br /> m <br /> ADDRESSPDX <br /> e <br /> EMERGENCY/FIRE NUMBER ROAD NAME � <br /> I <br /> Uav <br /> LEGAL DESCRIPTION (see tax receipt) <br /> 1 I <br /> y <br /> CONTRACTOR O t' <br /> f J <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> SANITARY _ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o o <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z p /l <br /> o J� <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 (N),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions In feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building .0 <br /> measurement to the ordinary high water mark of lake,stream,or river. <br /> 4. H separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE UED. an o y <br /> PLOT PLAN A o a <br /> X60 <br /> C oa <br /> N <br /> "j <br /> 19 1L �' G) <br /> ¢ See— <br /> SLX.('Utr 0 <br /> 56' � <br /> ill <br /> °_ <br /> "1 <br /> 2y' ;TE 1le(-14Cd_ - `) <br /> tj <br /> 3� <br /> a <br /> CONDITIONS OF PERMIT: g 3.. ,z C <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. = m �•� 1 <br /> P _ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 0) <br /> I '� y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. W �'' `: ' L') ? m <br /> Ei <br /> € e O <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of m knowl- ': O i 9 <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all i forma- w w <br /> In <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that th s infor- <br /> motion I am providing will be relied upon by the County Of Burnett Wisconsin in determining whether to issue a permit.. I $r$ $ <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 <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> m i <br /> D <br /> SIGN MERE <br /> (signetturgooff owner or building contractor) (date) <br /> ZONING ADMINISTRATOR �I. - <br /> $ E <br /> 8MM+«« <br /> TOWNSHIP PERMITS MAY BE REQUIRED (J g tA mZt <br /> $ $ $ $$$ $ to <br />