Laserfiche WebLink
(I`)I L6�1 ;" - <br /> Burnett Conty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d T oo <br /> APPLICATION FOR — LAND USE — PERMITS . £ <br /> d = <br /> TO THE ZC*IING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and H <br /> located asshown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m Cc <br /> Burnett(ounty Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> fegulatians Of the State of Wisconsin. 'o <br /> w m <br /> w m <br /> / / c <br /> OWNER G 3 93 ./ TELEPHONE �/�� 7 /7� 0 O <br /> ADDRESS yry ZO.f'i4-/f Zd <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION�(see tax receipt) &Tt1 CSm ✓, 1in /Oo 60 /y_ aO " <br /> CONTRACTOR <br /> s <br /> 61 I <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> o <br /> SANITARY PRIVY FILLING/GRA ING CAMPING UNIT SUBDIVISION a ^ \ <br /> o LL <br /> ,r 0 <br /> STRUCTURE/ADDITION USE: /),fes 9e 5 0 <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) m <br /> Z o <br /> o � <br /> 3 <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). <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). o <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. Q <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 <br /> 0 <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED 3 <br /> PLOT PLAN l A o 0 <br /> d <br /> Z <br /> 5 T� C I Y- 347 e <br /> o <br /> �' LJ <br /> N <br /> 2 00 <br /> 30 <br /> � ,d <br /> L � <br /> D o c m m a : T <br /> am <br /> CONDITIONS OF PERMIT: $ m c a o a M <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 5 ? Tz <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. M »� m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. I O I O <br /> 8 [ <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my know) o m '� I m <br /> edge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all informa <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ m $ <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 o <br /> access to the above described premises at any reasonable time for the purpose of inspection. 0 8 B <br /> m ` 3 x : <br /> SIGN HERE <br /> (signature of owner oru' in (date) x <br /> r�QQ'' o <br /> ZONING ADMINISTRATOR - / ( -7-- [ $ <br /> TOWNSH PERMITS MAYBE REQUIRED N N 'p ,u, o m <br /> 888888 8 ) <br />