Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator a m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and / \ <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m ; W <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin, N m <br /> c '? <br /> OWNER �{,U�/� �� - TELEPHONE .S ��� D <br /> d <br /> ADDRESS —1C <br /> EMERGENCY/FIRE NUMBER1/0,3"3 <br /> � ROAD NAME <br /> T � <br /> LEGAL DESCRIPTION (see tax receipt) 1 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ?OCESSORY STRUCTURE_'YK ADDITION o <br /> m O <br /> SANITARY PRIVY-- FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> STRUCTURE/ADDITION USE: c o <br /> ( oma/Cabin;Commercial Busin ;Bedroom; Deck;etc.) 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). r <br /> 2. Show the location of the we I (W),septic tank (ST),and drainfield (DIF). 4 <br /> 3. Show dimensions infeet oft efollowing:(a)building to all lot lines,(b)buildingto 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 submitt d by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a N <br /> 7I Z o <br /> PLOT PLAN <br /> o111 a <br /> L C OQ 0 <br /> � c <br /> Jr 1p� <br /> `J <br /> O N <br /> 3 <br /> I <br /> c �c" M <br /> CONDITIONS OF PERMIT: e mg�m? `z �S .0 5' <br /> i. DRIVEWAY MUST MEET DRIVEWAY WI A ENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> ATION IS RESTRICTED ALONG SHORELINE. =m 9 <br /> 3. NO GRADING OR SHOREL kND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �" ' 62 '' ` m <br /> g aE C <br /> 1 declare that this application fir Iuding any accompanying schedule)has been examined by me and to the best of my knowl- o m <br /> edge and belief it is true,correc and complete.I acknowledge that I am responsible for the detail and accuracy of all informs. m <br /> tion contained in this applicatio i(including any accompanying schedule)and I further declare that I recognize that this infor- - if $ p <br /> mation 1 am providing will be r lied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 ; 0012 o <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- r <br /> plication.1 agree to permit coun y officials charged with administering county ordinances or other authorized person to have ON o <br /> access to the above described premises at any reasonable time for the purpose of inspection. Z T , 3 o x <br /> e <br /> SIGN HERE- " U d" Ai i <br /> /(signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR ` g <br /> H N N W N N N N m <br /> TOWNSHIP PERMITS MAY BE REQUIRED O N N el .0 O <br /> 0000000 Co <br />