Laserfiche WebLink
of A Cc my <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m -.a c o <br /> APPLICATION FOR - LAND USE - PERMITS . 4 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work desc ribed and Q w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett Courtly Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. _ <br /> N pl <br /> � w � <br /> OWNER 1 a ilr TELEPHONE _ n FO <br /> lJ o � <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> A <br /> LEGAL DESCRIPTION (see tax receipt) Ivn1 <br /> 1 <br /> CONTRACTOR -K/i--_1/ IC _ r <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O <br /> SANITARY_ PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> o < <br /> r <br /> STRUCTURE/ADDITION USE: 0 0 <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) z m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate No h (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 l 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 I ned and <br /> dated by the owner. i7 <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE SSUED. on 3 <br /> PLOT PLAN z o <br /> Ao a <br /> N <br /> C <br /> achP� ash- <br /> �e i P ►a— <br /> y <br /> O <br /> O <br /> 0 <br /> m <br /> O y <br /> N <br /> r <br /> Z <br /> l � <br /> r� C <br /> 8 a In2In <br /> CONDITIONS OF PERMIT: ti a � F n o g-g . <br /> a <br /> < � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o z18 ,2 <br /> £ ' Z <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. i : m <br /> I declare that lois application(including any accompanying schedule)has been examined by me and to the best of ' <br /> y knowl- <br /> `• E ` E C <br /> R . . <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of aill informs- a m a m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- is B C <br /> metlon 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 am providing i this ap- <br /> plication. I agree to permit County officials charged with administering county ordinances or other authorized persort to have V o <br /> access t0 the above described premises at any reasonable time for the purpose Of Inspection. <br /> n <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) ? o <br /> ZONING ADMINISTRATOR Trn Playn'too-q-) <br /> g <br /> N: <br /> TOWNSHIP PERMITS MAY BE REQUIRED M[ y <br /> rnONx$ 8888888 ) <br /> F <br />