Laserfiche WebLink
a� / <br /> Burnett County 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Admiistrator m m ; o <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned her m <br /> rsig hereby makes application for a Permit for the work tlesc ibetl and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requireme nts of the m c - <br /> Burnett Courtly Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and `1 <br /> regulations of the State of Wisconsin. l� <br /> G � <br /> C <br /> OWNER /G 6 f� TELEPHONE <br /> m <br /> �/ p� o <br /> ADDRESS .r,T i�2• ^ _ e` Ali_i .I <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (seetaxreceipt) T <br /> r- <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE ADDITION o <br /> n 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo o <br /> STRUCTURE/ADDITION USE: � �� 6T1 �����(—s ° <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> 0 <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 (W),septic tank (ST),and drainf laid (DF). 4 <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. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be s Igned and <br /> dated by the owner. C <br /> NOTE: BUIL ING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 a m <br /> 1A Z v <br /> PLOT PLA ° n <br /> M <br /> a <br /> M >j <br /> CA19d m <br /> > <br /> n O <br /> r (� 0 <br /> O <br /> Gbh , <br /> �l <br /> (b 3'0O <br /> , <br /> J � - <br /> fbr, .�s � � � <br /> o \ <br /> � \rrr Y) Z <br /> _ / I 31 <br /> a r1 I C <br /> S� <br /> eN cl°., <br /> w <br /> 0aFm <br /> /q g� 2-a2 c,m z <br /> CONDITIONS OF PERMIT: /ire A v $2; 1 C 8 g <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o FIQ - - <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. J) G <br /> v,�. QY <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best f my knowb �... o E �i '• C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy o all informa- ' . "'m H T <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize t at this infor- j::j:: $p E O <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issu a permit. I <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providii g in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized pason to haveQ- O p <br /> access to the above d 'bed Dromi t any reasonable time for the purpose of inspection. ' m : <br /> T i i 3 : <br /> m � m <br /> m <br /> SIGN HERE 7011JI!(sig of ow a or building contractocontractor)ZONING ADMINISTRATOR <br /> �MNN+�NMN�+ T <br /> TOWNSHIP PERMITS MAY BE REGUIRED I o u $v (R $ m <br /> 88888888 ai <br />