Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator �/ ( m o ' a <br /> APPLICATION FOR — LAND USE — PERMITS 3' <br /> _ o <br /> TO THE ZONINQ ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v N <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m C <br /> Burnett Cuunty Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> 0 <br /> regulations of the State of Wisconsin. N <br /> m o <br /> OWNER f�O���t �ysh y TELEPHONEp a £ <br /> %/S <br /> ADDRESS ;2 3'fi,�r— Cr <br /> � /?o' / <br /> EMERGENCY/FIRE NUMBER / �7 � j ROAD NAME e�,u T V <br /> LEGAL DESCRIPTION (see tax receipt) 5d t/17X(,7 R 16 0 0 p r7 �60 ,r/F39d <br /> L,/ C1— <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE DDITION o <br /> n L <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> J <br /> N � <br /> o )( / <br /> STRUCTURE/ADDITION USE: �/ <br /> �-PC � <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) o o <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). 0 <br /> 3. Show dimensions infeet of thefollowing:(a)building to all lot lines,(b)bulldingto center line of road,(c)building O <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 0 <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSIFE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. an a ur <br /> 71 Z a <br /> o 0 <br /> PLOT PLAN n <br /> a <br /> m � <br /> Se, m . <br /> N N <br /> 0 <br /> O <br /> O J <br /> O <br /> J <br /> O <br /> 111\I Z <br /> N O,C N B n a f m <br /> '2- M <br /> q m _ szC8 = ,07+ <br /> CONDITIONS OF PERMIT: c f? - 9,z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. In <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ut �LI declare that this application(including any accompanying schedule)has been examined by me and to the best of my know I- <br /> ge loaf I am responsible for the tletail and accuracy of all in «edge and belief it is true,correct and complete.1 acknowledforms- <br /> ; . O <br /> tion contained in this aDPlication(including any accompanying schedule)and I further declare that I recoize thatiinfor-mation I am providing will be relied upon by the County of Burnett Wisconsin indetermining whethera prmiI o <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am DrovI in in this ad,`. <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have m N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. .n ; 3 0 t <br /> m : V A N : <br /> to e A <br /> M <br /> 0 : <br /> SIGN HERE -(date) <br /> (at net re of ow or building contractor) <br /> o : <br /> ZONING ADMINISTRATOR ' <br /> au+u�rnwen v. T <br /> TOWNSHIP PERMITS MAY BE REQUIRED O N N m N <br /> � Ii 00000000 <br />