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/ <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 m- 2 <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 v m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the a $ <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. w m <br /> c m <br /> O <br /> OWNER TELEPHONE <br /> d � /p m_ � <br /> ADDRESS "DY6 o(J o� 77 I,r 1 1 bI e 1 <br /> EMERGENCY/FIRE NUMBER a s a 7? ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE !c ADDITION O <br /> SANITARY PRIVY FILLS <br /> G/GRADING CAMPING UNIT SUBDIVISION <br /> m � <br /> STRUCTURE/ADDITION USE: 4 0 ° o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o 0 <br /> 3 <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 infest ofthefollowing:(a)building to all lot lines,(b)buildingto center line of road,(c)building .0 <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 9 <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. an a c <br /> PLOT PLAN A ° / <br /> � o <br /> C l <br /> C <br /> _ W <br /> 0 <br /> N <br /> O <br /> J <br /> N <br /> O-r <br /> 2 <br /> a <br /> f <br /> R c ODErn <br /> m <br /> 33:e R rn <br /> g� 2, <br /> CONDITIONS OF PERMIT: aF. 'z �8 g� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2, REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. — W' rn <br /> 1 NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. y m0 <br /> g[ er C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl o- <br /> ac �l <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accury of all informa �+p« m <br /> �. v <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this III I r. l p <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. $� $ <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. T <br /> m : <br /> SIGN HERE <br /> (signatreuf owner or building contractor) (date) <br /> � € <br /> ZONING ADMINISTRATOR <br /> NNgZA in <br /> TOWNSHIP PERMITS MAY BE REQUIRED o v <br /> 88888888 in <br />