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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI Milln Office of Zoning Administrator ; f c <br /> APPLICATION FOR — LAND USE — PERMITS <br /> e <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes applicatbn for a Permit for the work described and � 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 laNs and <br /> regulations of the State of Wisconsin. w m° <br /> m m <br /> c <br /> OWNERt7 r TELEPHONE �S i O — C <br /> ADDRESS �- At <br /> EMERGENCY/FIRE NUMBER ROAD NAME W / Ke_ <br /> LEGAL DESCRIPTION (see tax receipt) •�.0 <br /> CONTRACTOR l� <br /> TYPE OF PERMIT(S):/DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p —may <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o Qj <br /> / �� w � <br /> STRUCTURE/ADDITION USE: � � o <br /> (Home/Cabin;Commercial Business;Be oom;Deck;etc.) z v <br /> o ° <br /> 9 <br /> N <br /> } <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 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. C <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 71 o y <br /> o <br /> n <br /> PLOT PLAN � <. <br /> C�Ke <br /> C ' <br /> �o <br /> Ar <br /> (� <br /> Parc �. <br /> A- <br /> 1 <br /> N <br /> .p' C <br /> Prr N <br /> 6k a arm 8)E/6 <br /> 1 <br /> KeID Z <br /> f <br /> &Int <br /> m. •� --aM <br /> CONDITIONS OF PERMIT: o Q --a <br /> R. ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Zm I Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p ° - <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. - Z'" '. Gt h j In <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of y knowl- <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 .• •+ m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that his infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit.-L <br /> ; $ $ <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 perac n to have - <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> rq <br /> SIGN MERE��i i0 <br /> (signature of owns or b Wing contractor) (date) <br /> ZONING ADMINISTRATOR Kn an9aizl3 g <br /> TOWNSHIP PERMITS MAY BE REQUIRED o -8 m <br /> 8888 8 ! ori <br />