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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m o I o <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m <br /> located as shown herein. The un Jersigned 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 a _ <br /> V <br /> regulations of the State of Wiscor sin. rn m <br /> w � <br /> m O <br /> OWNER TELEPHONE o. <br /> m <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME " <br /> R> <br /> LEGAL DESCRIPTION (see tax race pt) J <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/ UILDING GARAGE/ACCESSORY STRUCTURE ADDITION yT o <br /> o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> ' \ o <br /> STRUCTURE/ADDITION USE: ° g <br /> v <br /> Home/Cabin;Commercial Business; Bedroom; Deck,etc.) z o <br /> O 9 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) I ` <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 thew II ,se r <br /> (VV) tic tank ( T), and drainfield (D�. 4 <br /> 3. Show dimensions in feet oft efollowing:(a) building to all lot lines,(b)buildingto center line of road,(c)building - <br /> measurement to the ordinar.f 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 G <br /> dated by the owner. Q o _i <br /> NOTE: BUILDING/STRUCTURE I-COMONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 41 3 rn <br /> 1I z Q <br /> PLOT PLAN n o n <br /> fn ) o <br /> C . <br /> :J <br /> 0 <br /> o <br /> 0 <br /> O <br /> b <br /> O � <br /> N I1' <br /> Z <br /> Ac > a0 � <br /> m ag� 5r c= Im <br /> 37 <br /> CONDITIONS OF PERMIT: ^ <,w: Q C8 0 r'o <br /> 1, DRIVEWAY MUST MEET D IVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F it <br /> 2. REMOVAL OR CUTTING F TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. It h =^t r»: <br /> 3. NO GRADING OR SHORE AND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �' 'No 3 E o p <br /> �i a�i i C <br /> I declare that this application(i cluding any accompanying schedule)has been examined by me and to the best of my know,- 1, o . 0 s< : - <br /> edge and belief it is true,correc and complete.1 acknowledge that I am responsible for the detail and accuracy of all informa- '7- : •^w N m <br /> tion contained in this applicati n(including any accompanying schedule)and I further declare that I recognize that this infor. -- p <br /> motion I am providing will be lied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I �.)� $`� mi <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 person to have O p <br /> access to the above described premises at any reasonable time for the purpose of inspection. m ; i 3 0 <br /> N N O <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) <br /> N <br /> _r O X <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REOUIRED o N..444 m <br /> $ $ $ $ Saw <br /> x x x <br /> w <br /> o i <br />