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0�) c&nP, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ; m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> d m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m (} <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 Ordina ice,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wiscoi sin. y m <br /> m <br /> , I m � O <br /> OWNER " TELEPHONE <br /> ADDRESS <br /> Qi <br /> EMERGENCY/FIRE NUMBER ` - ROAD NAME <br /> i <br /> (G <br /> LEGAL DESCRIPTION (see tax rece pt) . <br /> � � ' c <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/E UILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> o <br /> J ^ <br /> o <br /> STRUCTURE/ADDITION USE: <br /> v <br /> Home/Ca)ain;Commercial Business; Bedroom; Deck;etc) �� J 0 o (� <br /> � � o L, <br /> m <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 /> r <br /> 2. Show the location of the wall (W),septic tank (ST), and drainfield (DIF). 0 <br /> 3. Show dimensions in feet oft efollowing:(a) building to all lot fines,(b)building to center line of road,(c)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. 7I a rn <br /> Milt <br /> c <br /> PLOT PLAN 2 1 / �d o n <br /> SeCSl3A�f fc'r"'�T ID <br /> 0 <br /> fn9� n` = <br /> (IJAJ <br /> Sty w�fi N � <br /> 0 <br /> J <br /> N I� <br /> O <br /> J <br /> p <br /> O � <br /> m <br /> Z <br /> x r�u,-v y <br /> m a <br /> D s m M <br /> CONDITIONS OF PERMIT: <br /> i. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. oF 0 <br /> 2. REMOVAL OR CUTTING TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> iL <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o <br /> edge and belief it is true,Correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- im m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- cl p <br /> mation I am providing will be r lied 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 cour ty officials charged with administering county ordinances or other authorized person to have N <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 b <br /> SIGN HERE <br /> (sit n of owner or building contractor) I — o c <br /> ZONING ADMINISTRATORAFK ` g <br /> rn a d• us x p�� T <br /> I b TOWNSHIP PERMITS MAY BE REQUIRE ' ', ! o � N &' N �g5 0 <br /> L:�.._.�-._ .. o o o o R R m <br /> M <br /> O <br />