Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m <br /> APPLICATION FOR - LAND USE - PERMITS . <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirem msof the m = U3 <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and thelaws and �_ $ <br /> regulations of the State of Wisconsin. o <br /> N Ol <br /> c <br /> OWNERL //`.7 TELEPHONE F <br /> ADDRESS 5-0 _ j,/H17E�7 SFAC dp-4/IG 4` T 3 W <br /> 1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> S <br /> LEGAL DESCRIPTION (see tax receipt) 1 <br /> CONTRACTOR U� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT A�— SUBDIVISION o 0 <br /> 0 <br /> STRUCTURE/ADDITION USE: ii CL / o .> <br /> (Home/Ca ' Commercial Business;Bedroom; Deck;etc.) Z T <br /> 0 0 <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). <br /> 3. Show dimensions in feet of the 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 sl ned 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 SSUED. '11 a ur <br /> = c <br /> PLOT PLAN � a <br /> C�'1 <br /> r o Yl�� C I <br /> o� m <br /> ooi - Cc--Low, <br /> MX Lo M <br /> m <br /> N <br /> �J <br /> � z <br /> W � <br /> CONDITIONS OF PERMIT: o m y, Z E O g ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m S- -Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. o £ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �, m <br /> : 8IT . <br /> ' o <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of ny knowl- o ; C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of a I informs- a a w m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liability which may be a result of the County of Burnett relying on this information I em providing n this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to havei O o <br /> access to the above described promises at any reasonable time for the purpose of inspection. r 3 <br /> SIGN HERE J A 9 <br /> (signature of owner or building contractor) (date) QJ <br /> ZONING ADMINISTRATOR <br /> 8 <br /> TOWNSHIP PERMITS MAY BE REQUIREDM <br /> 88888888rmn <br />