Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Admi istrator m m o of <br /> APPLICATION FOR — LAND USE — PERMITS 2 E <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work desc ibed and Q u 0 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the M a �j <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 /> w m <br /> u m <br /> m � <br /> OWNER / ELEPHONE n O <br /> o <br /> ADDRESS E'Cr T t - �/p0I m <br /> Ti-c�i �fC%� - J7GlJ <br /> EMERGENCY/FIRE NUMBER /(J (� ROAD NAMEC) <br /> LEGAL DESCRIPTION (seetexreceipt) <br /> CONTRACTOR G // <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ✓` GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> o <br /> w <br /> STRUCTURE/ADDITION USE: � X, C' K/ p <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) <br /> Z i <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 dreinfield (D17. 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 <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 sllined and <br /> dated by the owner. M o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSTrE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 0 v N <br /> PLOT PLAN Z <br /> � o n <br /> r1 VUUVVV�V��,JJJ <br /> I <br /> s' <br /> V N � I <br /> O / (y <br /> � UI <br /> o � <br /> Z <br /> ✓ )fid!Lam/` �{'c./•/ <br /> �DD�Om <br /> m <br /> CONDITIONS, PERMIT: SQ'�1rfiO J ermll . ' o m gz cffi g <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN DAYS OF PERMIT ISSUANCE. c Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. �N i y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. R1 <br /> X : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of i ny knowl- O t <br /> edge and belief it is true,correct and Complete.I acknowledge that I am <br /> 0 D 9 responsible for the detail and accuracy of al informa- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that his infor- 7-� v Q <br /> mation 1 am providing will be relied 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 n this <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized pe n to have p i <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE <br /> ignaturee of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR - <br /> TOWNSHIP PERMITS MAY BE REQUIRED MM <br /> oiRi� �N� iKFSm <br /> 88888888 rmii <br />