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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54572 Office of Zoning Administrator 5 ; 0 o <br /> APPLICATION FOR - LAND USE — PERMITS m o ZA <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v a <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. w <br /> E o <br /> T M TE <br /> OWNER �.lOLEPHONE <br /> h n 4 ( 1 I��U ��- <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> i <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING �ARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION�_ 0 <_ <br /> w r- <br /> 0 o_ <br /> STRUCTURE/ADDITION USE: 0 v <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z o <br /> c 0 <br /> � T <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 (NS) and Indicate North (N). 5 <br /> 2. Show the location of the well (W),septic tank (ST), and dralnfieid (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 <br /> measurement to the ordinary high water mark of lake,stream,or river. <br /> 4. B separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and O <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. <br /> o I <br /> PLOT PLAN t1 `- <br /> chPr C C I I G a <br /> ve I �, I I�1L/ O <br /> 1N y I <br /> o� _ <br /> mm <br /> �Z��'�n�g° Ip <br /> g =2 ; <br /> CONDITIONS OF PERMIT: .: ' S.2 : : =1 <br /> 1. DRIVEWAY MUST j <br /> MEET DRNEWAV WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o ; ; :-it yg E 9 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Z+? k ' i m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. - Q -[' : C <br /> 5i <br /> I declare that this application(Including any accompanying ached <br /> has been examined by me and to the best of my knowl- g : 3 <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- "' i o ? G <br /> tion contained In this application(including any accompanying schedule)and 1 further declare that I recognize that this infor. $ $ <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue •permit. 1 , , <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.lhe county <br /> als rewith lhOrdinances <br /> other authorized parson to have <br /> ccess totabove ddescribedP�^ipe st any asonable time for te purpose of inspection. <br /> SIGN HERE (data) <br /> - <br /> (signature of owner or building contractor) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED om <br /> 9918 MCA <br />