Laserfiche WebLink
Burnett Fon ity 7410 Co. Rd. K, No. 102, Siren, WI 54872 <br /> Office of Zoning Administrator <br /> APPLICATION FOR - LAND USE - PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the � <br /> 0 <br /> Burnett Court pp " <br /> County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. I <br /> v _ <br /> OWNER - Ir(� TELEPHONE <br /> EPHONE �(�8r <br /> �—'57 - <br /> CO <br /> ADDRESS R f <br /> EMERGENCY/FIRE NUMBER // /l c} ROAD NAME C SS /O w>✓ C ' <br /> LEGAL DESCRIPTION (see tax receipt) <br /> -r <br /> CONTRACTOR <br /> / r V <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE <br /> ADDITION o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT ��� O <br /> SUBDIVISION -- o <br /> o <br /> STRUCTURE/ADDITION USE: -G& <br /> m r <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> v <br /> Z o <br /> O a <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 in feet ofthefollowing:(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. 71 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. Q O <br /> PLOT PLAN a <br /> z ` <br /> 5 P_e L}tt � �l �, m o a Z <br /> .0 < <br /> c 0 �1 <br /> R� p <br /> N <br /> O <br /> 7 <br /> O <br /> y Iya l <br /> A <br /> Z <br /> C V <br /> G <br /> S c ayi 0a 0 <br /> CONDITIONS OF PERMIT m <br /> � � nafm <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. 2 0,0 - L Z =t° M <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ° -I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 9' : <br /> y r <br /> a° ` <br /> I declare that this application(including am <br /> ny accompanying schedule)has been examined by me and to the best of my knowl. $ m C <br /> tion contained in this application(including any accompanying schedule)and I further declare that I <br /> edge and belief it is true,correct and coplete.I acknowledge that I am responsible for the detail and accuracy of all <br /> mthis informs- <br /> T <br /> recognize that infor- m 0 <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o� o G <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am prod person to haveviding in this t. 1 o o <br /> Plication.I agree to permit county officials charged with administering county ordinances or other authorizen»i <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> o P,SIGN HERE <br /> m <br /> o <br /> ( It ure of caner rwilding contractor) (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED oEgN m <br /> C00000 o ((n <br />