Laserfiche WebLink
erl <br /> BliMrlett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS m o <br /> TO THE70NING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q U <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirenric ms of the $ <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and _ <br /> regulations of the State of Wisconsin. o <br /> m m <br /> w � <br /> 0 Q <br /> OWNER t TELEPHONE n E <br /> E O A <br /> w <br /> ADDRESS azc) — g <br /> EMERGENCY/FIRE NUMBER I r ROAD NAME - 1,/e� I q� C) <br /> V 1� I I <br /> LEGAL DESCRIPTION (see tax receipt) �� IV <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING_ GARAGE/ACCESSORY STRUCTURE ADDITION <br /> 2 O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> o < <br /> ° <br /> STRUCTUREJADDITION USE: <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;9C.) Z <br /> o ° <br /> v <br /> m <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 North (N). <br /> 2. Show the location of the well (YV),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,( )building -4 <br /> measurement to the ordinary high water mark of lake,stream, or river. <br /> 4. H separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be s gned and <br /> dated by the owner. O o <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I 3 N <br /> PLOT PLAN T Z E <br /> o { <br /> o n <br /> OUer go r II C �Z <br /> 3� SP PT c Z J <br /> o <br /> 01y, <br /> 0 <br /> Z <br /> too 0 —77 <br /> z <br /> 21 <br /> yeGL a I 2, Uel <br /> ,ti� _ stag <br /> />...-moi ' / 'a. <br /> }� �p$� aa' $ <br /> CONDITIONS OF PERMIT: �i6 1�-D, R' �-�, j •z 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c E �`� <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. u m <br /> E : ` 10C <br /> _ <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best o 0 my knowl- o <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- a a <br /> ': w <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize thi t this infor- - E 19 S p <br /> matlon 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providin in this ap- I j ' <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized per on to have m <br /> access to the ve descnAM premises at any reason le time for the purpose of inspection. m ; . 3 , a , <br /> SIGN HERE <br /> (sign ow or buil0lnp contractor) (date) H <br /> ZONING ADMI ISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIREDI l 0 N Nn O N N <br />