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arywl <br /> I County 7410 Co. Rd. K, No. 102, Siren, WI 54072 Office of Zoning Administrator 0 : f c <br /> APPLICATION FOR - LAND USE - PERMITS 3 <br /> HE ZONING ADMINISTRATOR:The undersigned her Q ° <br /> erSlg hereby makes application far a Permit for the work described and a <br /> -ted as shown heroin. The undersigned agrees that all work shall be done in accordance with the requirernerts of the o c n <br /> irnett County Lard Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the 13ws and . " t <br /> gulations of the State of Wisconsin. m <br /> w o <br /> -hu �OSI � <br /> OWNER TELEPHONE ^+ E <br /> ADDRESS i _ i 1 <br /> 1 <br /> EMERGENCY/FIRE NUMBER ROADNAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR— C _ r <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAG CCESSORY STRUCTURE ADDITION p 1 <br /> o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> w � <br /> STRUCTURE/ADDITION USE: 6 °— <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> 0 0 <br /> m <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 Nort I (N). <br /> 2. Show the location of the well (W),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 <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1A o N <br /> PLOT PLAN A c S <br /> O <br /> 4s <br /> o - <br /> � N <br /> I <br /> o I�, <br /> m <br /> O y <br /> w <br /> n I� <br /> Z <br /> D <br /> f <br /> m <br /> z <br /> CONDITIONS OF PERMIT: ^ z ' Z CS g 2 �. <br /> z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN SO DAYS OF PERMIT ISSUANCE. i o f � , <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �'i i '; rn <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 0— <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of i ill informs- m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize the this infor- � p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue permit. I ►�� 1 $ $ <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- i ;r`-J i <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized Pon on to have p <br /> access to the above described promises at any reasonable time for the purpose of inspection. 44 <br /> i $i p <br /> m � - <br /> SIGN HERE N <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR — ' n • I': 8 E <br /> NNN+'NN+ T <br /> TOWNSHIP PERMITS MAY BE REQUIRED o i$a $�'N�So!�'S' m <br /> 88888888 ai <br />