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Cl <br /> / <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI SM72 Office of Zoning Administrator V 'oa o <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> d o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordii tance,Sanitation Code, aV with all other applicable County Ordinances and the laws and 3. n 1 <br /> regulations of the State of Wis opsin. el/ man I H m <br /> n o <br /> OWNER G �. TELEPHON��'E <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER 3 J �� ROAD NAME <br /> LEGAL DESCRIPTION (see tax r eipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> oSANITARY PRIVYF DUNG/GRADING_ CAMPING UNIT SUBDIVISION o <br /> 0 <br /> STRUCTURE/ADDITION USE: • ° <br /> (Home/Cabin;blarnmercial Business; Bedroom;Deck;etc.) z o <br /> o v <br /> m <br /> a <br /> DIRECTIONS FOR PLOT PLAIN 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 /> r <br /> 2. Show the location of the ell (W),septic tank (ST), and drainfield (DF). � <br /> 3. Show dimensions in feet the following:(a)building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordin 3ry high water mark of lake, stream, or river. 0 <br /> 4. If separate plans are subn iitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. <br /> 00 <br /> NOTE: BUILDING/STRUCTURE LC CATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a yr <br /> 71 Z `o <br /> PLOT PLAN n o a <br /> M o <br /> Hoq <br /> d � <br /> 0 <br /> o <br /> N <br /> o Jt <br /> 2 ii rn2 D mg <br /> 6 11gv5 '-9.nNa = 31 <br /> CONDITIONS OF PERMIT: ^ 0 S.: Z C S � T+ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o 9 Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHO ELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. u : ' O 2 :Ni m <br /> al g o: p <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl <br /> 0 . <br /> m <br /> edge and belief it is true,torr ct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- r^m m <br /> tion contained in this applica ion(including any accompanying schedule)and I further declare that I recognize that this infor- B p <br /> malion 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 <br /> further accept all liability whi h 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 have ; O N p <br /> access to the above describedpremises at any reasonable time for the purpose of inspection. T 3 . , <br /> (p m A N 4V <br /> S-7 5 : 61 N:O <br /> SIGN HERE <br /> ( ignature of owner or building contractor) (date) <br /> � ? <br /> X : <br /> ZONING ADMINISTRATOR <br /> � x <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 o m <br /> 0 <br />