Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872Oftice of Zoning Administrator - `�+ - ' � <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE 20NING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work descri and a <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requireme s of the m c <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the I cos and <br /> regulations of the State of Wisconsin. = o <br /> /' w m_ <br /> OWNER _� � (y- ( 4G' C��SOz�TELEPHONE /�� — 3��� m _ E <br /> ADDRESS (o H fZC ` I A p - m <br /> EMERGENCY/FIRE NUMBER <br /> ROAD NAME <br /> LEGAL DESCRIPTION (see taz receipt) <br /> CONTRACTORZti G� I <br /> T c G <br /> TYPE OF PERMIT(S): DWELLING/BUILDING&AL GARAGE/ACCESSORY STRUCTURE -A le ADDITION 1j" <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> o <br /> ^) <br /> R N �. <br /> STRUCTURE/ADDITION USE: � `F i U ) 5 /\ <br /> (Home/Cabin;Commercial Busi ss;Bedroom; Deck;etc.) Z <br /> o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 9 <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). 0 <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF), lDo <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)I wilding <br /> measurement to the ordinary high water mark of lake,stream, or river. <br /> 4. B separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sig ed and X <br /> dated by the owner. O O <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FO ONSITE VERIFICATION BEFORE A PERMIT CAN BE UED. � 3 W <br /> PLOT PLAN <br /> �Ou o 'n <br /> N <: <br /> I-4 m <br /> G I <br /> G <br /> M <br /> Ad <br /> I) <br /> ,(o b¢ O� Arjr14 U4 'r130 IN <br /> O <br /> IaFf <br /> J pn 7 41 8J) <br /> J � I <br /> 117 -- I ( ( <br /> d <br /> SGAy � � <br /> i <br /> I� <br /> -v <br /> 2. � v <br /> CONDITIONS OF PERMIT: `"I v o R. B o.O m <br /> c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. (y Z m ? Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. o E ' : ` to': <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. /t) <br /> 1 declare that this 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.1 acknowledge that I am responsible for the detail and accuracy of all i forma- m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- `' ? a : 0 <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a piunnit. I 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in his ap- I <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person o have is p <br /> access to the above described premises at any reasonable time for the purpose of inspection. `• <br /> _ tom y m <br /> SIGN HERE <br /> (signature of owner contractor) (date) - <br /> ZONING ADMINISTRATOR g <br /> TOWNSHIP PERMITS MAY BE REQUIRED ~t�a <br /> ppp «� <br /> O to N pO <br /> G C C C 8 8 <br /> j(/) <br />