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"0 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 0 m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m c <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. w m <br /> OWNER TELEPHONE m <br /> m <br /> ADDRESS 1, <br /> EMERGENCY/FIRE NUMBER ROAD NAME ((�� <br /> LEGAL DESCRIPTION (see tax receipt) JJ <br /> CONTRACTOR "DO c r U <br /> TYPE OF PERMR(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o` ° <br /> 0 <br /> m r <br /> STRUCTUREJADDITION USE: ° o <br /> v <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o 0 <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). <br /> r <br /> 2. Show the location of the well (W),septic tank (ST),and dralnfield (DF). ° <br /> 3. Show dimensions Infest of thefollowing:(a)buildingto all lot lines,(b)buildingto center line of road,(c)building .1 <br /> measurement to the ordinary high water mark of lake,stream,or river. Q <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. () R <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 a N <br /> 11 Z a <br /> PLOT PLAN (� ° n <br /> ched 14 m <br /> V, I � �a � ��3.� 0) <br /> �m <br /> o <br /> o <br /> N <br /> 1 <br /> D mvbva) r ➢ Doy <br /> 4'a 1R0 am m <br /> a = ]) <br /> CONDITIONS OF PERMIT: Z m' Q w c 56 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. p F S T•Z : -1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _=�'• <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. i O n E mO <br /> g? C <br /> 1 declare that this application(Including any accompanying schedule)has been examined by me and to the best of my 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- .113:: rn <br /> rn <br /> tion contained In this application(Including any accompanying schedule)and I further declare that I recognize that this infor- 7i om m <br /> matlon 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $s $ <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• w <br /> plication.1 agree to permit County officials charged with administering county ordinances or other authorized person to have O S <br /> access to the above described premises at any reasonable time for the purpose of inspection. • <br /> m $ <br /> A <br /> « : « 8 : <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) ' $ ? <br /> ZONING ADMINISTRATOR �- 1 o <br /> i��,bN~ ri <br /> TOWNSHIP PERMITS MAY BE REQUIRED ft$8 8 8 8 8 8 8 rn <br />