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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator w : o <br /> 5 a <br /> APPLICATION FOR — LAND USE — PERMITS m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 9 v <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the $ <br /> Burnett County Lard Use Ordinance,Sanf[ffikx1 Code, and with all other applicable County Ordinances and the laws and _ <br /> regulations of the State of Wisconsin. m m_ <br /> OWNER TELEPHONE e E <br /> ADDRESS ��U I�5 F1��CY• WZ m V <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION t7 <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o` ° n' <br /> STRUCTURE/ADDITION USE: O o <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) z �J . <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 North (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 -1 <br /> measurement to the ordinary high water mark of lake,stream,or river. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. am o m <br /> Z v <br /> PLOT PLAN A 0 a <br /> IN <br /> , i <br /> 0 <br /> m <br /> I_ <br /> N <br /> n W <br /> z <br /> 1 <br /> f <br /> F m <br /> 4. g•2 —•a w . >7 <br /> CONDITIONS OF PERMIT: Z Z g is ? ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o f ? <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. y' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �" ` m <br /> i C <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 informs- IT <br /> tion contained In this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mallon I am providing will be rolled upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I ( $ $ <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 i ' <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. ,n <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) <br /> i <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED a 99 9051$ m <br /> 888888188 U) <br />