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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator UP o a <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> w <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and �2 m ° <br /> located aeshown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. <br /> m m <br /> c <br /> OWNER /A) 41Y TELEPHONE111£000 <br /> ADDRESS ( V::'- <br /> C-�5, V fes, I7,�•t ii�>_g Q rid w I S e <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 p <br /> V n o <br /> SANITARY PRIW—_/\ FILLING/GRADING CAMPING UNIT SUBDIVISION o r. <br /> J \ / 0 <br /> STRUCTURE/ADDITION USE: �+ lr q a <br /> (Home/Cabin;Com ercial Business; Bedroom;Deck;etc.) z v <br /> o ° <br /> a <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 ofthefollowing:(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. 0 <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. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I o N <br /> 11 z Q <br /> PLOT PLAN o a <br /> ichoL <br /> C i <br /> to <br /> m 6 - <br /> � N <br /> 1C <br /> 0 <br /> o <br /> o <br /> m <br /> Z <br /> f <br /> � 11 <br /> X <br /> g � �.� ��afm <br /> CONDITIONS OF PERMIT: = m < <br /> < N : <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 0 = <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. M <br /> i <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ' o pi i 62 M <br /> $B <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of in 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- v'm>: T <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- B o : p <br /> motion I am providing will be relied upon by the County or 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- <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have ON o <br /> Ji <br /> access to the above described premises at any <br /> reasonable time for the purpose of inspection. m ; 3 bo <br /> 9 A <br /> O :� <br /> SIGN HERE �//rA _ . <br /> (signature of�or building contractor) (date) ; <br /> ZONING ADMINISTRATOR �IG <br /> `na �Fn aenT <br /> TOWNSHIP PERMITS MAY BE REQUIRED 'o N u N g m <br /> $ $ $ o $ $ $ y <br />