Laserfiche WebLink
®Y? ear <br /> Burnett Coifnty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator w m o c <br /> APPLICATION FOR — LAND USE — PERMITS 3_ <br /> a <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. m° <br /> m m <br /> OWNER TELEPHONE <br /> O <br /> ADDRESS Zl , 01-o as- Ljee,JfGR 'owl . _449 <br /> 93 m <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> I <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION o <br /> n c) <br /> SANITARY _ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> o < <br /> '^ r <br /> STRUCTURE/ADDITION USE: o °— <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z <br /> 0 0 <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). <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 IN <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. an 3 w <br /> c <br /> PLOT PLAN o a <br /> m ° <br /> all Jj <br /> I UtJ N <br /> 0 <br /> _ <br /> o <br /> N <br /> Z <br /> IN <br /> G <br /> -g aymy1Ml <br /> ¢ m <br /> CONDITIONS OF PERMIT. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F S %`z : 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =Co: i M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 2391 m <br /> of ap 0 <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- »: mid = C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- «.m r m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 1� a � g p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I ore 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- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have ON o <br /> access to the above described premises t any reasonable time for the purpose of inspection. r 3 -oo 0 <br /> m <br /> Vo A N : <br /> m > - <br /> - f9- 13 � $ <br /> SIGN HERE .8 <br /> (sighitdre of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR ` 1/m Han r4" � <br /> TOWNSHIP PERMITS MAY BE REQUIRED o N N N N m <br /> 000'p o0o U) <br />