Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator CIO 'a - s <br /> m E ° <br /> APPLICATION FOR — LAND USE — PERMITS — <br /> d O <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 a m <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 r, <br /> regulations of the State of Wisconsin. o <br /> m m <br /> 1 PQ /J c <br /> M <br /> OWNER TELEPHONE n £ <br /> ADDRESS <br /> I 4 ,� yl z,�, �Z(a. s �'!i"Y ,� M <br /> �V <br /> EMERGENCY/FIRE NUMBER � , ROAD NAME tl Q <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR Ok / C1, <br /> ti•c NLt Y LUh <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE J�- ADDITION Z/ p <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> o <br /> STRUCTURE/ADDITION USE: aY'/l a o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) J& f/-ar /h.4.-_. _ Z o <br /> v�(M �l�I�j P 9 � <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 (D17, o <br /> 3. Show dimensions in feet ofthefollowing:(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 signed and 0 <br /> dated by the owner. 0 c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSFE VERT ICATION BEFORE A PERMIT CAN BE ISSUED. 7I 3 rn <br /> PLOT PLAN S C tam- o a <br /> O < <br /> m o <br /> � c <br /> ni 1e(rrifT m <br /> 1 <br /> Zr D�NCM<LT n <br /> o <br /> n = <br /> rt <br /> o <br /> Z <br /> i <br /> 35 I <br /> -------------- m o c a m n � m <br /> / M — a Q _ a - <br /> m <br /> CONDITIONS OF PERMIT: �Z- ? m < : Z m o > > 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z M o ,2 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. o :E <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. : O n O <br /> g c' <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o m M m <br /> edge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all informs- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I g m <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this a w <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O N' <br /> access to the above described premises at any reasonable time for the purpose of inspection. m g <br /> 3 <br /> SIGN HEREODt.,. �Z�"� -NiG .Ir�r�s..' // / " I ` � . <br /> IV 4(signature of owner or building contractor) f (date) ' a <br /> - Fr <br /> ZONING ADMINISTRATOR �+ I/h l��1U1 G1iTFJ <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> ut ut o N0 .0 m <br />