Laserfiche WebLink
ey1 (,bv, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d -0 o z <br /> APPLICATION FOR - LAND USE - PERMITS _ <br /> m 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. -- o <br /> a m <br /> c �^ <br /> OWNER WOM Lk_ RAffrj�T COMP TELEPHONE / 'S- _ �� ( I n O <br /> ADDRESSRT 'Boy- ISI GRNnI I.J gL RG ��t( 84a 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME ��'m <br /> I <br /> LEGAL DESCRIPTION (seetazreceipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT17 <br /> SUBDIVISION o 0 <br /> y <br /> STRUCTURE/ADDITION USEr <br /> : 0 0 <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z <br /> o ° V' <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) ;K <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 (DF). o <br /> 3. Show dimensions infeet ofthefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building i <br /> measurement to the ordinary high water mark of lake,stream,or river, iNNNNIIII <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. O O <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11113 y <br /> PLOT PLAN Mill z Q <br /> � o n <br /> M W �. <br /> m t <br /> o <br /> C I <br /> 0 <br /> 0 <br /> o <br /> m <br /> o <br /> N <br /> Z <br /> <L� <br /> iic�wr>> 0v <br /> pg� 2ao-i em <br /> CONDITIONS OF PERMIT: a < N_. C ?5 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F . ' g�Z 0 <br /> : <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. I N m <br /> �[ �� . <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of C <br /> my knowl- v 0 . <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- `b' B g G <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o'$ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this ap- <br /> plication. I agree to permit county Officials charged with administering county ordinances or other authorized person to haveI`v' <br /> O m O i <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 0 <br /> 0 <br /> € 3A 0i <br /> SIGN HERE o E E <br /> (signatu of owner or building contractoq `� ) ;. '._ ; ` E <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED MAY 2 5 ro ro w ro ro'r�"'^i r <br /> 000g 0000N <br />