Laserfiche WebLink
94 C&YAA <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 5 � � c <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and u <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirerrm nts of the $ _ <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and _ <br /> regulations of the Stale of Wisconsin. c <br /> y� aaG1� �l�w Af�DORESs; <br /> OWNER Johanna Hoffman TELEPHONE c E <br /> ADDRESS Siren, WI 54872 <br /> EMERGENCY/FIRE NUMBER 6504 ROAD NAME State Rd. 70 ` <br /> 1 r- <br /> LEGAL DESCRIPTION (seetaxreceipt) pcl. G. L. 2 & 3, (Lot 1), Section 35, T39N, R16i, 1 <br /> Town of Menon <br /> CONTRACTOR r� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY % PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION n <br /> 0 <br /> STRUCTURE/ADDITION USE: Sanitary Only o <br /> v <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) o c L <br /> A F ' <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). I �l <br /> 2. Show the location of the well (W),septic tank (ST), and dralMield (DF). r- <br /> 3. <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of food,( )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 al gned and 9 <br /> dated by the owner. O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I o y <br /> PLOT PLAN n o S <br /> C <br /> N W <br /> M <br /> 11 <br /> t <br /> SEE ATTACHED <br /> 0 <br /> 3 \ <br /> t7 ti <br /> N <br /> Z <br /> N <br /> 1 <br /> v� <br /> f <br /> CONDITIONS OF PERMIT: o Z;: C g ' ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o� `z : 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. rg� i A <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r" '• !S E rn <br /> Lr <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best ol my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of kit informs. i « « <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize the this infor- p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 gr$ 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providin In this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized ps on to have - <br /> access to the above described premises at any reasonable time for the purpose of Inspection. �R7 <br /> -n JF <br /> SIGN HERE Wade Rufsholm 4/3/95 <br /> (signature of ow r r fJylld n n tor) (date) « <br /> E � E <br /> ZONING ADMINISTRATOR i 8i i <br /> TOWNSHIP PERMITS MAY BE REQUIRED ���g m <br /> 18 1888$ a, <br />