Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator �1 0 t Tl 1 l..Z'I <br /> APPLICATION FOR — LAND USE — PERMITS m d J P <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and y <br /> 0 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance,Sanitation Cotle,and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. - <br /> 0 <br /> w m <br /> NOWNER TELEPHONE ��s �i9Z 1 y v O <br /> /yam <br /> ADDRESS <jle <br /> // \ e, r//I �Vr r r d <br /> EMERGENCY/FIRE NUMBER � TC// ROAD NAMECdtZ'I/y <br /> LEGAL DESCRIPTION (see tax receipt)G <br /> o,� <rAAI>M Li/ 7 .X<7 i%/f 3 yV 7e <br /> CONTRACTOR /n, / <br /> ��19'C l� /t'g(1 to v4 /� V�nAr/l-�i/��� plft•�/1 .S1/� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION <br /> O (� <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> C o < <br /> / / J <br /> STRUCTURE/ADDITION USE: S d ra� ' ��...(('_¢ 3� �'- `" j <br /> 0 <br /> (Home/Cabin;Commercial usiness;Bedroom;Deck;etc.) <br /> 9 o <br /> o v <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), o <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. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE E VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on o <br /> N <br /> PLOT PLAN �1 z ` <br /> � o a <br /> C 0 <br /> M <br /> I <br /> J <br /> o <br /> 0 <br /> O <br /> O <br /> O <br /> N <br /> W <br /> J <br /> i <br /> ti <br /> CONDITIONS OF PERMIT: v <. Z A <br /> C . K <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F T' -4 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - N a <br /> 1 NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m <br /> Y'„ c� � O <br /> gi ci <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m `� a <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor $m N <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8 m 8 <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. id, <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O N p <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 8 iq <br /> p M <br /> V A N <br /> SIGN HERE , . -� !� -/� m ` m g <br /> J a <br /> N <br /> p <br /> (sign Lure of owner or building contractor) (date) s <br /> 9 <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS If BE REQUIRED <br /> <nrnoui .889MM <br /> 888888 $ 80 <br />