Laserfiche WebLink
Burnett County 7410 Co. Rd. K. No. 102, Siren, WI 54872 Office of Zoning Administrator 5 $ f c <br /> APPLICATION FOR - LAND USE - PERMITS 1 <br /> TO THEZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work _described and a = C Ca <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the $ —C <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the, <br /> h laws and <br /> regulations of the State of Wisconsin. c <br /> m m <br /> c <br /> OWNER Gene HalvorsonTELEPHONE (805) 328-9935 , E <br /> mm <br /> ADDRESS 200th Irene Street Bakersfield, CA 93305 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME Blomgren Road (_ <br /> LEGAL DESCRIPTION (seetureceipt) pcl. NW SE, SEciien 20, T38N, R17W, Town of Daniels <br /> i <br /> CONTRACTOR <br /> a <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY % PRIVY FILLING/GRADING CAMPING UNITSUBDIVISION o- o 0 <br /> w <br /> — <br /> STRUCTURE/ADDITION USE: Sanitary Onl0 0 <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) <br /> z o <br /> 0 v <br /> 3 <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 No h (N). <br /> 2. Show the location of the well (VI),septic tank (ST),and drainfield (DF). .°r. <br /> 3. Show dimensions In feet of the following:(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 si 3ned and M <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST- BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. all c y <br /> PLOT PLAN c g <br /> P a <br /> M o ' <br /> P T ' <br /> a <br /> ffl <br /> ) <br /> N <br /> O <br /> SEE ATTACHED ' <br /> o <br /> O <br /> S <br /> m <br /> N <br /> i IAI <br /> Z <br /> PQn <br /> J <br /> f <br /> CONDITIONS OF PERMIT: a <br /> F;2.. Z c S' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. 0 m g Z 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 0 f ' '• ` N' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m <br /> h ' C <br /> Lr i <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl• <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of a I informs- w°y'}}•!�� <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor• B S In <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue permit. 1 $� $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing n this ap• k <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. ; Rg <br /> i � a <br /> SIGN HERE Wade Rufsholm 5/1/95 3 ' <br /> (signature of ow b Ildt g r (date) <br /> ZONING ADMINISTRATOR r �pq <br /> «gHg -I <br /> TOWNSHIP PERMITS MAY BE REQUIRED N N N g m <br /> $ 8 $$ $$ vi <br />