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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ; m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS m s <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 'a w <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 /> 0 <br /> regulations of the State of Wisconsin. w m <br /> c m <br /> m O <br /> OWNER // TELEPHONE -, a <br /> C Z dtesdn <br /> ADDRESS 1 C h W I -F -u 0 CJ o 6c e / -T 3 m <br /> ran ttLi L <br /> i <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) \ <br /> 1 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O , <br /> � O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> '^ r <br /> � 0 0 <br /> STRUCTURE/ADDITION USE: � !.^ <br /> (Home/Cabin;Commercial Business;Bedr om;Deck;etc.) o <br /> m <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 dralnfield (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. 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. 41 o N <br /> 1I Z `o <br /> PLOT PLAN o n h J <br /> m o C <br /> I� <br /> I <br /> m <br /> 0 <br /> o <br /> I� <br /> m <br /> I� <br /> Z <br /> v� <br /> D o c m m n a g m <br /> o . Q .ag am m <br /> a D 2 a 0 o 3 <br /> CONDITIONS OF PERMIT: m' �^ o ro <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. e <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. 0 <br /> gm " C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- ii : i m p <br /> plete.I acknowledge that I am responsible for the detail and accuracy o <br /> edge and belief it is true,correct and comf all informs- m <br /> a : <br /> y!S [ <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- S C) <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $o 8 <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- iw <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. m , 3 g <br /> o A r <br /> SIGN HERE' date) <br /> ur tx. m <br /> (signatof owner or building contractor) ( a l a i <br /> �� 8? XE <br /> ZONING ADMINISTRATOR ` E ` ` '. <br /> TOWNSHIP PERMITS MAY BE REQUIRED N S m <br /> 88888888v� <br />