Laserfiche WebLink
i4_) <br /> Burnett Ca mty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m *0 c o' <br /> APPLICATION FOR — LAND USE — PERMITS <br /> s <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 requirements of the 3 $ <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. H m <br /> w <br /> OWNER 1 ' ) TELEPHONE E <br /> 1000 lfikE B6605rf em <br /> ADDRESS �� 8,55 e "r po'l Ra _ GKfinrS 9upG , wi . <br /> EMERGENCY/FIRE NUMBER �a1.1-� ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR `^ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> n 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> 0 <br /> 0 <br /> m r <br /> STRUCTURE/ADDITION USE: o 0 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> 0 0 <br /> 0 <br /> � � e <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 (yi),septic tank (ST),and drainfield (DF). <br /> 3. Show dimensions In feet of thefollowing:(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 NJ dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 9 n y <br /> PLOT PLAN Z a <br /> M �y <br /> m <br /> C <br /> m ' <br /> i <br /> 0 <br /> n <br /> O <br /> I17 <br /> O I 1— <br /> J <br /> O � <br /> N V <br /> Z <br /> Il <br /> 0 .0 aam <br /> gm <br /> m. D 0 m a m <br /> g.� <br /> _ a <br /> CONDITIONS OF PERMIT: =0 F Z.: B o o no -i <br /> 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. io o <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. G E <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ? u C ? p <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. S [ m o <br /> edge and belief It is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informa• c : yy!!m i m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. g ao C <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. 1 8 a 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- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. ' Y <br /> 'n 3 $ xi <br /> A m <br /> SIGN HERE <br /> (sibrialure of owner or building contractor) (date) <br /> '.ONING ADMINISTRATORIn <br /> 8 <br /> TOWNSHIP PERMITS MAY 8E REQUIRED 8 fA 91��'o o m <br /> 8888888rn <br />