Laserfiche WebLink
(Tact <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 34872 Office of Zoning Administrator d m a o <br /> 'APPLICATION FOR — LAND USE — PERMITS 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and H <br /> located as shown herein. The undersigned agrees that all Work shall be done in accordance with the requirements of the 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 /> rn d <br /> N � <br /> 1 C <br /> OWNER IOr r/n 0 _ l TELEPHONE <br /> /DCII �n2J(.�, ( I e <br /> ADDRESS Rd, --fid., 5L ,8001 7c�Cl Ii S, 0)IV <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> n <br /> LEGAL DESCRIPTION (see tax receipt) <br /> G . <br /> CONTRACTOR l <br /> J <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDFFION p <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> o < <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> o V CJ <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 drainfieid (DF). o <br /> 3. Show dimensions infest ofthefollowing:(a)buildingto 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. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 71 3 rn <br /> PLOT PLAN 1A Z c <br /> o n <br /> m <br /> ve <br /> m � _ <br /> w <br /> N <br /> 0 <br /> 0�2V <br /> N <br /> Z <br /> ( a <br /> M2. <br /> CONDITIONS OF PERMIT: a N. Q c 8 .005 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F : : ' <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =yn <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. E� m <br /> o : a�IF O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. o m C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- a a <br /> L7 m <br /> m <br /> m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this nfor- <br /> � <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I g`$ 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 have ' k`: ; O N 0i <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> m mo ` <br /> SIGN HERE w o <br /> (signature of owner or building contractor) (date) '. - « <br /> ZONING ADMINISTRATORv1nY r ���rga��l <br /> r008008960 . bou) <br /> ofr`�nwTTOWNSHIP PERMITS MAY BE REQUIRED NNNNNNm <br />