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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator Um o 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3. ' <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes m <br /> g by 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 00 OC <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 <br /> 'nV m <br /> OWNER �'�( r I^1 I TELEPHONE a f <br /> P,J LLI`JJJ \ ` M, f m M <br /> ADDRESS X11 W. 6�ckila, 1/ P 11 f I r tN �o ) 0 <br /> EMERGENCY/FIRE INuUMBER ROAD NAME t <br /> LEGAL DESCRIPTION (see tax receipt) ' <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE ADDITION <br /> , <br /> SANITARY PRIVYo v <br /> FILLING/GRADING CAMPING UNIT SUBDIVISION o _ . <br /> 0 <br /> w r <br /> STRUCTURE/ADDITION USE: o ° <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z � <br /> 0 0 <br /> 0 <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 drainfieid [DIF). <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. C 4- <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M r , <br /> dated by the owner. 0 0JF� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED, on a w <br /> C <br /> PLOT PLAN A o a <br /> 4*a,,h ,d csrnju <br /> m L€ <br /> o <br /> J <br /> s <br /> 0 <br /> 0 <br /> Ioj <br /> N <br /> O <br /> JO Z <br /> ( z <br /> F <br /> h o c o. m or o n <br /> 2m N mL <br /> a < d wo 3 <br /> CONDITIONS OF PERMIT: mC a Z c .0 0 <br /> t. 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. _ ^' m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 'm c i C <br /> C <br /> mA : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- a o Mm <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- . Fw m w 0 <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 $ m $ <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 hav <br /> 0 .0 p <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> f V A N <br /> A 0 <br /> M N <br /> SIGN HERE to <br /> (signatureof owner or <br /> building contractor) (date) x <br /> ZONING ADMINISTRATOR `�'�_/�¢,/ 8 ' ' <br /> TOWNSHIP PERMITS MAY BE REOUIRED <br /> � ai7o � oo � m <br /> $ $ $ $ $ $ 88rmn <br />