Laserfiche WebLink
V�Dn( C' <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ( - o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3_ <br /> Fo TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 0 <br /> � H <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> 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. y l/ <br /> w m <br /> C O <br /> OWNER �ef,-NS G�,n^er, TELEPHONE o ,C' <br /> ADDRESS Ll/td tS '41,,r P/P' /-00 ---ppp�--- �/J� SJ qjC mm <br /> 1 <br /> EMERGENCY/FIRE NUMBER Q31 ROAD NAME - <br /> ///jjj <br /> LEGAL DESCRIPTION (seetaxreceiipt)t) f I / / t-/I Tyati, TI, <br /> CONTRACTOR 'm <br /> TYPE OF PERMIT(S): DWELLING//CBU/ILDINGf9 GARAGEIACCESSORY STRUCTURE ADDITION-X- p V V <br /> O ^ <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo Il <br /> o < <br /> 0 <br /> STRUCTURE/ADDITION USE: I� //1V�r �E,�`-�/��f+n^ K� � o <br /> (Home/Cabin;Commercial Business:Bedroom' 2O�"�. <br /> ; Deck;etc.) Z <br /> O <br /> -7 <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). r� <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). = \l <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. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. O c1 <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 71 3 N <br /> c <br /> PLOT PLAN o a <br /> M a <br /> C x3 <br /> M ' <br /> I <br /> O <br /> THIS PERMIT BEING ISSUED SUBJECT TO A SANITARY PERMIT �O " <br /> BEING SECURED AND A MOUND SYSTEM BEING INSTALLED. Q <br /> oC <br /> APPLICANT ACCEPTS ANY AND ALL LIABILITY CONNECTED WITH r <br /> ANY CHANGES REQUIRED WITH THE REQUIRED SANITARY SYSTEM. v <br /> N <br /> Or �\ <br /> �l <br /> 2 <br /> i x <br /> (n-UDDO V <br /> —g� ' am g0 m m <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c m o 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. £ =N 9 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N 62 A <br /> b : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- <br /> PP (including Yaccompanying ) 9 G <br /> tion contained in this application includin an schedule and I further declare that I recognize that this infor- B <br /> mation I am Providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I olii <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 Om o <br /> access to the above described premises at an easonable time for the purpose of inspection. m ; 3 'oo 0: <br /> f m 0 AON : <br /> M w O <br /> SIGN HE ' [ w: $ <br /> (signa(wetof owner of uil mg con ractor) (date) G . 8 : <br /> ZONING ADMINISTRATOREN�E <br /> TOWNSHIP PERMITS MAY BE REQUIRED O N NT N NT VN m <br /> 8 <br /> e $ Poog $ oow <br />