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C)N CQMPU T ER/SCANN�- <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI U872 Office of Zoning Administrator C/l . o c <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m ° <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � <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 Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and J._ <br /> regulations of the State of Wisconsin. y 0 <br /> a m <br /> ---�l C £ <br /> og S�rin�5 )C�i�Plail� �� <br /> DWNER TELEPHONE <br /> 4DDRESS L\L '� I � 8 l <br /> MERGENCY/FIRE NUMBER ROAD NAME <br /> t <br /> _EGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p C1 <br /> U, <br /> 0 i <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> o <. <br /> w r i V <br /> STRUCTURE/ADDITION USE: ° o <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <br /> z o <br /> o � <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). o <br /> 3. Show dimensions In feet of the following:(a) building to all lot lines,(b)building to center line of road,Ii 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. a N <br /> PLOT PLAN ? <br /> o a <br /> 0 _ <br /> C '1 <br /> W <br /> ,44d <br /> wq <br /> c,5f <br /> "�� <br /> V'r <br /> I � 4 <br /> ° <br /> N YJ <br /> O <br /> _7 <br /> 7 <br /> N <br /> 1 <br /> o - z-� <br /> CONDITIONS OF PERMIT: < H' `� ro <br /> 1. 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. ai N » <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �' m <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- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- N N m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. IE $ $ <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 ' <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE N <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> 404MN~40P t" �t <br /> TOWNSHIP PERMITS MAY BE REQUIRED 8 $ �IN'�' m <br /> 88898 gig�8 y <br />