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on <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m c o <br /> APPLICATION FOR — LAND USE — PERMITS . >E <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work descr bed and � w <br /> s <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremet its of the o °c <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the I aws and <br /> regulations of the Stale of Wisconsin. m <br /> w � <br /> m <br /> O <br /> OWNER � e I -=r c- TELEPHONE n � <br /> U m m <br /> ADDRESS m <br /> 1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME U <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> o — <br /> u, <br /> STRUCTURElADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) ` <br /> Z <br /> o o <br /> a <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 /> 2. Show the location of the well (VI),septic tank (ST),and drainfleid (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. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be si ned and 9 <br /> dated by the owner. 0 c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE OZILIED. 11 c y <br /> PLOT PLANZ <br /> � o n <br /> A (v <: <br /> M o <br /> c M <br /> -ate <br /> W <br /> o <br /> m <br /> O y <br /> N YY �l 77 <br /> r <br /> Z <br /> D <br /> � bn r�v�n��saov <br /> CONDITIONS OF PERMIT: o w: co <br /> g <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ` U)` a <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. i m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. I w <br /> 2 ` C_ <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of al informa- E «m« ? M <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that 1 his infor- ' E $ B C <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing i i this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized perso n to have ` O <br /> access to the above described premises at any reasonable time for the purpose of inspection. m ' <br /> m <br /> SIGN HERE « <br /> (signature of owner or building contractor (date) - <br /> b NQ <br /> V <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP O&MITS MAY BE REQUIRED �'�"" `"� M <br /> o4X,a' `.b'4X ,or iK i4 m <br /> $ $ 88$888W <br />