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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and _0 <br /> located as shown 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 - <br /> 0 <br /> regulations of the State of Wisconsin. w w <br /> m <br /> m O <br /> OWNERr '( I � I TELEPHONE <br /> 1A.L- 111 f iA 1 <br /> ADDRESS tj l SC r , NyV m <br /> EMERGENCY/FIRE NUMBER ROAD NAME C A ) <br /> LEGAL DESCRIPTION (see tax receipt) <br /> i <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITIONw o <br /> n Ll <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o o �' <br /> STRUCTUR ADDITIO USE: /[y < <br /> (HomelCabin;Commercial Business; Bedroom;Deck;etc.) o 0 <br /> a <br /> _ I a <br /> -IONS FOR PL^T PLAN DRAWING: (Aerial or topview, <br /> 1. how the location andsize o a {EB)-anttall new buildings (NB) and indicate North (N). r <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). 4 <br /> 3. Show dimensions infeet of thefollowing:(a) building to all lot lines,(b)buildingto center line of road,(c)building <br /> measurement to the ordinary high water mark of lake,stream, or river. Q <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. Q o <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I o N <br /> _ 11 Z <br /> 5? Q <br /> PLOT PLAN. e A), ��S f° O�-rv�-P �r e��l� f—(�r�cQe� 7f9^�5 � o a <br /> C <br /> IT 0iC".i <br /> v a <br /> E l tl�tnl o <br /> c <br /> N r� <br /> to <br /> O �l <br /> rJ <br /> �1T b <br /> z <br /> ELI 2. F <br /> CONDITIONS OF PERMIT: I X m - ' C g <br /> 9,21. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. p f <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> NE 2)2 : m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. n to <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o : i <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I G <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 adminis ring county ordinances or other authorized person to have d o m ; <br /> access to the above describ premises at an <br /> as t' for the purpose of inspection. T 3 0 <br /> N m A N <br /> r N <br /> G ys . <br /> SIGN HERE vi <br /> (s t re f owner ilding contractor) - s <br /> o : <br /> ZONING ADMINISTRATOR g <br /> N N J N N N N T <br /> TOWNSHIP PERMITS MAY BE REQUIRED u v v O IT <br /> m <br /> o o o o o 0 o U) <br /> i b <br />