Laserfiche WebLink
Burnett County 7810 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administratorm m o c <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> d o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and H O <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 0O W <br /> regulations of the State of Wisconsin. y w C, <br /> w <br /> r_ <br /> OWNER ( O )'t ' TELEPHONE <br /> ADDRESS a 3 O 7 It�� tcn V'S-'4'„j — Gtz•.��ry <br /> EMERGENCY/FIRE NUMBER / ( pds ROAD NAME SS 4ryv,,/ <br /> U O <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR Fr <br /> TYPE OF PERMITQ): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o V <br /> �� O ^r <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> STRUCTURE/ADDITION USE: ° o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z o <br /> 0 0 <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). <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 N S� <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 2 <br /> dated by the owner. 0 o e ,J <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a N <br /> PLOT PLAN Z Q ` <br /> A o n <br /> w <br /> C <br /> y ' m <br /> b N <br /> CN <br /> 6` <br /> Q <br /> w_ <br /> n ) ICIO <br /> 2 = <br /> A O c e 0+ 0 a <br /> m m emM <br /> D <br /> _S'.. )v w <br /> CONDITIONS OF PERMIT: < : o T+ <br /> r _ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F '0 i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - <br /> � — : - <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ' o, ; <br /> 62i m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- aiC <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- a a m <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. 1 o� 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 d m m <br /> access to thea a described premises at any reasonable time for the purpose of inspection. ; . 3 8 9- ; <br /> M � O <br /> ��or <br /> SIGN MERE � 3 <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR JIjl� � - : <br /> ` J «.wd, m <br /> TOWNSHIP PERMITS MAY BE REOUIRED o N a a <br /> M <br /> 00 Doo IN <br />