Laserfiche WebLink
97 aYOA , <br /> ,ounty.7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Adminiktrator C m - o <br /> APPLICATION FOR - LAND USE - PERMITS <br /> m <br /> r£ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and i <br /> ded as shown herein. The undersigned agrees that all work shall be done in accordance with the requirementsm °of the a C (f` <br /> /urnett County lend Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and _ <br /> ,egulations of the State of Wisconsin. w m <br /> u io <br /> � (oSCOWNER �CtLS TELEPHONE ff <br /> m_ 0 <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER t3197S ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) S3,90 , g>r v U 9Ve , <br /> r <br /> CONTRACTOR c.c�— �r 1 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION&ano 1�� <br /> n Q N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 �l i <br /> t o <br /> STRUCTURE/ADDITION USE: cicel <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z o <br /> o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) I ` <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NS) and Indicate Nort i (N). <br /> 2. Show the location of the well (W),septic tank (ST),and drainfleld (DF). g <br /> 3. Show dimensions in feet of thefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building .4 <br /> measurement to the ordinary high water mark of lake,stream,or river. c <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be all ned and <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 13SUED. 71 a m <br /> 71 Z `o <br /> PLOT PLAN 0 a <br /> AAk c ,tA . a I, f`1 <br /> � In <br /> 0 IZ <br /> 1 <br /> N <br /> d -F� <br /> m <br /> Z <br /> m <br /> m. $* 2.o. x <br /> € 3 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c f 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` "' i mO <br /> QQ C <br /> 5 e <br /> 1 declare that this application(including any accompanying schedule)nes been examined by me and to the best o my knowl- R : � <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of ll informa- ? N N m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize ih t this infor- E E O <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providin 1 in this so- <br /> plication.I agree to peril county officials charged with administering county ordinances or other authorized per on to hwe O.; o <br /> access to the above described premises at any reasonable time for the purpose of inspection. go <br /> mn <br /> T O F <br /> is <br /> SIGN HERE <br /> (sig tura f owner Iding contractor) (date) <br /> ZONING ADMINISTRAT7�rww <br /> 4':g : ' <br /> ANN qNNr�(«� T <br /> NSHIP PERMITS MAY BE REQUIRED m <br /> 88888888 ami <br />