Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m a 0 <br /> APPLICATION FOR — LAND USE — PERMITS . <br /> N <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w0 <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 Code, and with all other applicable Courtly Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. H o <br /> N � <br /> C <br /> OWNER TELEPHONE j2 6 6 y y 7 y a F <br /> ADDRESS TT i0C,0 <br /> EMERGENCY/FIRE NUMBER y_� 7 ROAD NAME P or p TT ago <br /> LEGAL DESCRIPTION (see tax receipt) L-p <br /> T 1- ejS'`eTio:✓ .7y �owNS�.� Sforo d/-' _ <br /> CONTRACTOR <br /> L <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> o <br /> o <br /> r <br /> STRUCTURE/ADDITION USE: 5 g <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) <br /> Z o <br /> 0 0 <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). <br /> 3. Show dimensions infeet of the following:(a) buildingto all lot lines,(b)building to center line of road,(c)building -0 <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 G <br /> dated by the owner. n —, <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 v N <br /> c <br /> PLOT PLAN . Z � <br /> J, �Yr n o 0 <br /> m <br /> 7 <br /> 6' <br /> zy . N <br /> 0 <br /> co = <br /> 0 (, <br /> O <br /> m <br /> .S1. d r o c <br /> _U�f I <br /> EC' S z <br /> q s <br /> riPF •r��E <br /> Cor ,�iory a <br /> C— ra be at le4t,*t-30 9 p <br /> �v-0/h Td W�. R 0�Q�/'l [rT'l�,✓ <br /> CONDITIONS OF PERMIdiJ r iam00aDF Mm <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o E <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED." 'm C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- r w a to O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- I <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ m <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. m <br /> T 9 A <br /> SIGN HERE--'1` `" S <br /> (sign r of owne wilding ontracfor) 1 " (date) H <br /> o ' <br /> I <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED ` JUL 1 4 1992 <br /> N N N O N O O O m <br /> 88888888 v, <br />