Laserfiche WebLink
ell gm*o <br /> Bumott County 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administrator m a o 0 <br /> APPLICATION FOR — LAND USE — PERMITS m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Perms for the work described and o c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremea s of the $ <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and --C <br /> regulations of the State of Wisconsin. w m <br /> b 0 <br /> OWNERTELEPHONE f <br /> Hg1.tK AMu�tDSEN <br /> ADDRESS "777 1 LAKE DK . L1N0 LAKES , mti . Sso)4 i e <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tau receipt) <br /> 1 <br /> CONTRACTOR I <br /> 1 <br /> TYPE OF PERMIT( : DWELLING ILDING GARAGE/ACCESSORY STRUCTURE ADDITION 1 0 <br /> G) <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNITSUBDIVI N o G <br /> o <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin;Commvercial Business;B room;Deck;etc.) 0 d <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 Nort (N). <br /> 2. Show the location of the well (W),septic tank (ST),and drainf laid (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. 0 <br /> signed and <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sig9 <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE I SUED. 1A o N <br /> PLOT PLAN o a <br /> M <br /> }, C <br /> � <br /> /111tTL�'En �I N n <br /> I) <br /> VI <br /> Q <br /> rb <br /> 01 o' <br /> 0 <br /> N I(�/ <br /> � V1 <br /> m <br /> a <br /> JA <br /> C <br /> Z <br /> D V D D O y <br /> i£� a <br /> CONDITIONS OF PERMIT: ^ �,m' 'z g' ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 5 :MQ ' <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. i X <br /> C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best o my knowl- o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- » •"i m <br /> lion contained in this application(including any accompanying schedule)and I further declare that I recognize tha this infor- ' g 8 i O <br /> motion I 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 may be a result of the County of Burnett relying on this information 1 am providinC in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. P <br /> T � i <br /> m i a ` <br /> 0 i <br /> SIGN HERE <br /> (date) <br /> ZONING ADMINISTRATOR ` $'• <br /> TOWNSHIP PERMITS MAY BE REOUIRED '0 3 m N UN N SS m <br /> 88 $ 888 ai <br />