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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator - n �� z <br /> m m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3. <br /> m <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 c <br /> Burnett County Land Use OrdinaOf nce, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations o ,gr� Ai t U s �l�S� II S R IIIJJJIJ�J <br /> �y � QrC1tN w m <br /> e g <br /> OWNER ! ' ILf/GNGP TELEPHONE n F <br /> ADDRESS <br /> EMERGENCY/FIRE/INUMBER <br /> ROAD NAME <br /> /u <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n L7 <br /> SANITARY PRIW FILLING/GRADING CAMPING UNIT SUBDIVISION o` o <br /> STRUCTURE/ADDITION USE: AYv llSo 0 <br /> (Home/�Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> 0 0 <br /> o <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). a <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 ONSfTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 71 N <br /> PLOT PLAN z <br /> c <br /> se <br /> UQ <br /> N 75 <br /> Lj <br /> o a <br /> I <br /> N <br /> o � <br /> Z <br /> f <br /> v � <br /> L� <br /> D N (IJ (nr DDQ o <br /> mo o, c m m n f m <br /> m > > n o <br /> } a m = <br /> CONDITIONS OF PERMIT' <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F E T`� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - N : m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m C <br /> g c <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl m <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 e, m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. N <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8 m 8 <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 O a p <br /> access to the above described premises at any reasonable time for the purpose of inspection. 0 8 8 <br /> T <br /> SIGN HER <br /> (SiKatulm6f owner or i ng contractor) (date) a <br /> 0i x <br /> ZONING ADMINISTRATOR TOWNSHIP PERMITS MAY BE REQUIRED 88 NN 8E <br /> `8 9m <br /> f88 88888N <br />