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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 0 1 a <br /> APPLICATION FOR - LAND USE - PERMITS m �. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby by 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 <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable Courcy Ordinances and the laws and r <br /> regulations of the State of Wisconsin. o I <br /> J 1 m <br /> OWNER' TELEPHONE l-r - 3s/r✓� `l n O <br /> 1 <br /> ADDRESS Cj L- <br /> EMERGENCY/FIRE NUMBER i ROAD NAME <br /> IC �j II'J 1C(CZ C <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE,( ADDITION p n <br /> SANITARY PRIVY FILLING/GRADINGCAMPING UNIT ]� o oa, <br /> 1 / _ <br /> STRUCTUREIADDITION USE: <br /> (Home/Cabi ,Commercial siness; Bedroo ;Deck;etc.) Z <br /> o ° <br /> 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 North (N). <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). 5 <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. 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 ISSUED. 7I 3 y <br /> PLOT PLAN an Z $ <br /> C <br /> r <br /> ^ <br /> G <br /> N <br /> O <br /> O <br /> O y <br /> w <br /> •ZJ Z <br /> / IIS <br /> I <br /> TL's 5�ir m <br /> CONDITIONS OF PERMIT: c g c§ g <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. = <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. a _ '• ` al t0 9 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r^ 25�, i m <br /> DD (including Yaccompanying 1 Y Y - <br /> Ei <br /> I declare that this application lncludin an schedule has been examined b me and to the best of m knowl- <br /> edge <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- i «ro h <br /> In <br /> tion contained in this application(including any accompanying schedule)and 1 further declare that I recognize that this infor- i <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1g42 8 '. <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing in this ap- <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have p <br /> access to the above described premises at any reasonable ti a for the purpose of inspection. <br /> SIGN HERE a; <br /> (a na re of owne bullding co tractor) (date) xr�+ <br /> 2S ': <br /> ZONING ADMINISTRATO O 8 <br /> w' ea <br /> TOWNSHIP ERMITS MAY BE REQUIRED co g 8 m <br /> 9999 $ 8 m <br />