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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d� � 1 �,Z <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 'Z w o <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <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. <br /> c 2 <br /> OWNER <br /> 7n'� / TELEPHONE <br /> f <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER / l7JS ROAD N`Af/MEt�fl� <br /> LEGAL DESCRIPTION <br /> (lsee tax receipt) J ! J <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> S�GZyrGu <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; mercial Business;Pecroom Deck;etc.) Z <br /> 0 0 <br /> v <br /> m <br /> 3 <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). f <br /> 2. Show the location of the well (W), septic tank (ST), and drainfield (DF). o <br /> 3. Show dimensions in feet of thefollowing:(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. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. O 3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSRE VERIFICATION BEFORE A PERMITCAN BE ISSUED. on c t- <br /> PLOT PLAN Z <br /> M So <br /> �1J <br /> b / � 5Xx <br /> I <br /> P � <br /> N <br /> O <br /> 0 <br /> y <br /> r <br /> 3a' C) <br /> Z <br /> O C G M n 6 g im <br /> n _ 0 ' 0003m m <br /> CONDITIONS OF PER IT: o < < .Z m 0 <br /> 1 .DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUAN o F o T 0 <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. Yrn c) O <br /> 8 : m C <br /> 0 , <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o I 0 '� m <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informa- ur m w : O <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. I 8 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. u <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O (Xp <br /> access to the above described premises at any reasonable time for the purpose of inspection. n 3 8 8 <br /> m : m A " <br /> SIGN HERE <br /> (sl to of own buil 'ng contractor) (date) ' <br /> ZONING ADMINISTRATOR 3 8 <br /> TOWNSHIP PERMITS MAY BE REOUIRED m <br /> m <br /> 88888 vi <br />