Laserfiche WebLink
Burnett-County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator C o' o 0 <br /> APPLICATION FOR — LAND USE — PERMITS >E <br /> m , <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work desc ibed and a o <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the $ (n CI <br /> Burnett County land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and _ ^, IIIY%%%- <br /> regulations of the State of Wisconsin. m <br /> g' <br /> OWNER L �/Q/� (�.-7 TELEPHONE 6((k_ c�—T`'S—� v .i E <br /> ADDRESSZ i Pc(t/ lS / L461al i k S,roJU� 1 <br /> EMERGENCY/FIRE NUMBER ROAD NNAME n <br /> LEGAL DESCRIPTION (see taz receipt) (u( f (tiJ" r S— )-1 <br /> V <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING�_ GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n O <br /> SANITARY—� PRIW FILLING/GRADING CAbJPING UNIT SUBDIVISION o <br /> 1 0 <br /> STRUCTURE/ADDITION USE: ��'u:-E. ri, �L�(Ai� � ,�' G e - g o <br /> (Home meVcial Business; Bedroom;Deck;etc.) <br /> Z o <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). I(w <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). (/( <br /> 3. Show dimensions in feet ofthe following:(a) building to all lot lines,(b)building to center line of road,(c I building <br /> measurement to the ordinary high water mark of lake, stream,or river. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be si gned and a` <br /> dated by the owner. C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE SSUED. an o N <br /> PLOT PLAN _ <br /> o n <br /> bit <br /> m o <br /> ' s J <br /> G I� <br /> IN r <br /> m <br /> I� <br /> o � <br /> N <br /> /p \9 <br /> I � <br /> I <br /> F <br /> ' fm <br /> CONDITIONS OF PERMIT: <br /> o' mg�zg <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 8� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �' '• iO i m <br /> C <br /> I declare that lois application(Including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- in <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue & permit. I <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this III ' <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have o p <br /> access to the above described premises at any reasonable time for the purpose of inspection. e <br /> is ? i <br /> Is <br /> M � ' <br /> SIGN HERE ` <br /> (signature of aer r b Iidi c ret tor) (date) <br /> ZONING ADMINISTRATOR <br /> S <br /> € $s I <br /> TOWNSHIP PERMITS MAY BE REQUIREDM608 <br /> Mm$ $8ai <br />