Laserfiche WebLink
.t County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning AdminllStrator 1 t g o ` o <br /> APPLICATION FOR - LAND USE - PERMITS <br /> THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and o c � <br /> cated as shown herein. The undersigned agrees that all work shall be done in accordance with the requirementsof the ' <br /> urnett County Land Use Ordinance,Sanitation Code,and with all other applk:aWe County Ordinances and the laws and <br /> regulations of the State of Wisconsin. w' m <br /> u <br /> C <br /> OWNER Lauri Jorgenson TELEPHONE (612)540-1272 p <br /> 0 <br /> ADDRESS 3628 Majoe Avenue N. Robbinsdale, MN 55422 <br /> EMERGENCY/FIRE NUMBER ROAD NAME Minerva Circle <br /> LEGAL DESCRIPTION (see tax receipt) Lot 4, CSM Vol. 12, Pg. 112, Section 36, T41N, R16 ¢ <br /> Own O 1Se r <br /> CONTRACTOR <br /> C , <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> � O <br /> n <br /> SANITARY % PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONc < �1 <br /> 0 <br /> u r Vr <br /> STRUCTURE/ADDITION USE: Sanitary Only o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z o <br /> o v <br /> m <br /> 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) ` <br /> i. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate Nort i (N). r <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). S g <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. C 9. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be all ned and 9 <br /> dated by the owner. () 8 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE LIED. 11 o m <br /> PLOT PLAN Pg <br /> o <br /> C <br /> N <br /> A � <br /> SEE ATTACHED <br /> G � <br /> w R� <br /> O <br /> I LA) <br /> o' <br /> Ir <br /> z <br /> n D <br /> Y _ <br /> Q� <br /> f <br /> s K'Lo MM <br /> CONDITIONS OF PERMIT: o c g I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. 0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ° E 9 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �' •` ap <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best 01 my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and oeeuracy of i dl informs- L" m <br /> lion contained in this application(including any accompanying schedule)and I further declare that I recognize the this Infor- f 5 P ; p <br /> motion 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ $ <br /> further accept all liability which maybe a result of the County of Burnett relying on this information I am providin In this ap- p; <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized pe n to haw <br /> access to the above described premises at any reasonable time for the purpose of inspection. r <br /> SIGN HERE T1 <br /> (signature of owo Win o 1 A -itAte►- - E E <br /> ZONING ADMINISTRATOR ` gFvvv <br /> E <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> $8 8 8,88 rn <br />