Laserfiche WebLink
x <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator yr e <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes e <br /> g by application for a Permit for the work described and � c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and �Q <br /> regulations of the State of Wisconsin. w m <br /> m J <br /> OWNERLR ne 9{ TELEPHONE -w � O <br /> v o <br /> m <br /> O ! r <br /> ADDRESS /M nU-p�sO . <br /> EMERGENCY/FIRE NUMBER �-q dYn ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) O�j�� �s•-J3r-o Y''!� pC� C,L �. 3S 111W'2�t� <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING(((/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n L> 4U <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° --T• <br /> < / <br /> w � <br /> STRUCTURE/ADDITION USE: �a rde P_ <br /> (Home/Cabin;Commercial Business,Bedroom; Deck;etc.) z c <br /> 0 0 <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 (W),septic tank (ST), and drainfield (DF). o <br /> 3. Show dimensions In feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building aq <br /> measurement to the ordinary high water mark of lake,stream, or river. <br /> 4. If separate plana 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 STAID FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1A o y <br /> 1A z v <br /> PLOT PLAN ° n <br /> o <br /> C o <br /> a � <br /> a <br /> N <br /> C G <br /> d <br /> Y � c <br /> ` .z% _ <br /> ie` <br /> S ujjyj Mo <br /> 8 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. p Q i 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ? ^�„' m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- i `• M <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all Informs- <br /> fill <br /> tion contained In this application(including any accompanying schedule)and I further declare that I recognize that this infor- i i '• p <br /> mation I am providing will be rolled upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing In this <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 promises at any reasonable time for the purpose of inspection. T <br /> M i <br /> SIGN HERE <br /> 61 gnature of o er or building contractor) 20 / n <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRE _ 11994 J � m <br /> 8888 88 m <br />