Laserfiche WebLink
,M [;(;nnPUTEa/SCANNED <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator En v `�'z <br /> 0 0 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and rn ° <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 <br /> regulations of the State of Wisconsin. o <br /> c �? � <br /> OWNER ceo'� 1 GLC' �� a £J <br /> t�\ t C i CD <br /> TELEPHONE Q 7 <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) / k L/ /0_ -C_(f / <br /> r <br /> CONTRACTOR ) <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> CD <br /> o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> (� <br /> STRUCTURE/ADDITION USE: tr <br /> (Home/Cabin;Commercial B iness; Bedroom; Deck; etc.) <br /> 0 o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) r' ) <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). <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. O w <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. O <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSFTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '1I a Cn <br /> Z c <br /> PLOT PLAN oo <br /> a <br /> m N. <br /> sa Z--- <br /> G• M Z <br /> 0 <br /> lC� <br /> C <br /> O <br /> 7 <br /> N <br /> O <br /> 77) <br /> f0 <br /> 0 � <br /> N <br /> ✓J <br /> Z <br /> I <br /> D r�(n •Ocor- DD0 M <br /> M c =.> > 0a* m <br /> � � a H r. m M <br /> CONDITIONS OF PERMIT: m N.: z m 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o f.5. T : -+I <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. <br /> cd'i, d52 m <br /> o O <br /> 0 : ° , C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- Z.o : : CD m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- u►m v► : M <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- �i v C <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I a $�$ $ <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 n p <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 m <br /> -n 3 �L <br /> (D N <br /> (D <br /> H m ' <br /> SIGN HERE <br /> (signature of own o uilcl ng o tr to (date) <br /> 1 : o ; <br /> ZONING ADMINISTRATOR $ <br /> d+- in <br /> TOWNSHIP PERMITS MAY BE REQUIRED m <br /> $ o o $ $$ ai <br />