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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator Vm` a 0 ' z <br /> m m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <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 Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. - o <br /> m <br /> c ? F <br /> OWNER TELEPHONE �I'�„ 5q1 - 0_911_ o 0 <br /> ADDRESS JS�T '�- VflVARIA►J YR T�ID�Y MN "T�Z m <br /> 1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME `� m <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION O V <br /> o v <br /> o < <br /> H <br /> STRUCTURE/ADDITION USE: 5 g <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> Z o <br /> ° o ) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). C> <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building G1>0 <br /> measurement to the ordinary high water mark of lake, stream, or river. W <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 /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSFE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. c <br /> PLOT PLAN Z o <br /> o n <br /> m L <br /> c � <br /> I <br /> i <br /> ( <br /> ON <br /> L rb <br /> s <br /> N <br /> O <br /> J <br /> m <br /> O <br /> m \ <br /> Z <br /> (C <br /> —g� m <br /> CONDITIONS OF PERMIT: c m . C 2.0. n m <br /> � g <br /> Tcz:1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c m o: : gM <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 0 : =f m; <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. t veli S7 m <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> � � - C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- = g : rn <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I b`$ b <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- o , o <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> AA 3m'c <br /> SIGN HERE 0 : E <br /> (sig6a't4re of owner or building contractor) I <br /> (date) <br /> ZONING ADMINISTRATOR �l Ifl� 1'_Icl ruJ' (( MAR P g <br /> TOWNSHIP PERMITS MAY BE REQUIREQ `"" " `" " m <br /> o N N N <br /> m <br /> 000 000 <br /> 0 0 0 0 0 0 (n <br />