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Qi1 coy-f+, <br /> Bu4 tt Coy�nty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator Nm a o <br /> APPLICATION FOR — LAND USE — PERMITS . f <br /> d = <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q Z °^ <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 County Ordinances and the laws and <br /> regulations of the State of Wisconsin. H <br /> a V <br /> C <br /> OWNER �b <br /> TELEPHONE <br /> x E <br /> AL1 1 .ter' v 1 <br /> ADDRESS I tIL <br /> EMERGENCY/FIRE NUMBER I ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR + <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PPRIVY0 FILLING/GRADING CAMPING UNIT SUBDIVISION .`_ . <br /> STRUCTURE/ADDITION USE: o g <br /> (Home/Cabin;Commercial Business; Bedroom;Dec i(a c.) z o <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 drainfleld (DF). o <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 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 0 o o, <br /> PLOT PLAN T CL <br /> or f <br /> (over -t—J Al C c <br /> C I 1 = < <br /> 3a 5Q pT c �. <br /> v_ <br /> �7' 0 <br /> v /4c`��c <br /> N <br /> V— <br /> J ` 1UU 0 <br /> o - z <br /> n <br /> YeGLovi _ R, vcrc 1QD f <br /> L, ,p m <br /> D w <br /> �7V^V�V /"v" lC �FL <br /> CONDITIONS OF PERMIT: . 3,i c <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o <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. i '• m <br /> 10 <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- C <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informa• _ ; .w m H M <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- E a p <br /> motion 1 am providing will be relied 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- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have p <br /> access to thea ve descr ed premises at any reason le time for the purpose of inspection, <br /> In <br /> m a <br /> SIGN HERE <br /> (sign own or building contractor) <br /> ZONING ADMI ISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> O <br />