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oy ! � <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U -0o : <br /> APPLICATION FOR - LAND USE - PERMITS . <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the ° <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. m J <br /> OWNER TELEPHONE \ <br /> ADDRESS a j C�al�� nU ° p <br /> EMERGENCY/FIRE NUMBER ROAD NAME -'�— 1 m ��015- � <br /> LEGAL DESCRIPTION (see tax receipt) <br /> 411 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o G� <br /> n C) <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> 0 <br /> '^ r <br /> STRUCTURE/ADDITION USE: - - 0 0 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z v <br /> 0 0 <br /> m G <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). r <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). 0 <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. i <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 STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 111 v N <br /> 11 Z c <br /> PLOT PLAN c 4 <br /> III ° <br /> YN J <br /> L L ' a' <br /> 0 <br /> 0 <br /> m <br /> o G <br /> ,DF � <br /> z <br /> ti <br /> D <br /> X1 <br /> CONDITIONS OF PERMIT: < z : ? ffi S g.8 E <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. L7 i In <br /> !S E <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- per': 0 , <br /> edge and belief it is true,correct and complete.1 acknowledge that 1 am responsible for the detail and accuracy of all informs- — In <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- <br /> motion 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 $ $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 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 /> T <br /> M <br /> SIGN HERE `• «€ <br /> (signature of owner or buildingf SRI actor) (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED , m <br /> �88888�88 am) <br />