Laserfiche WebLink
Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 0Z <br /> APPLICATION FOR LAND USE PERMITS 3. p <br /> y ,. <br /> w y <br /> C <br /> OWNER /z ��+� �� � TELEPHONE <br /> L_ � <br /> HOME ADDRESS a /C t�- S�dO� � (���� �`�w� 9 <br /> r m <br /> 0 <br /> EMERGENCY/FIRE NUMBER v�l�,r/ {l ROAD NAME 2V47 ✓2 <br /> LEGAL DESCRIPTION(see tax receipt) LCI �( -. l in <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ y o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ m <br /> STRUCTURE/ADDITION USE: S FO f&6 F 20 )( w) f049 5+RA <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) m <br /> BUILDING CONTRACTOR: NOYS�C� E <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m '3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 � <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m �B <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND GRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS,ROADS,LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. to <br /> o I <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Cr <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z f <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. (� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY INJ <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> CD a i m <br /> 6. ;M0 <br /> 6. <br /> • c y s 3 <br /> 7. Z y CD Q 0 i <br /> 0 : <br /> l Cn m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofCL <br /> m S <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 'm m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- G O <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am lu <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> : <br /> SIGN HERE <br /> (signi r of o r or building contractor) (date) <br /> ZONING ADMINISTRATOR 1 e <br /> N N CA N N (A <br /> V1 V1 O V1 p1 p 0 0 <br /> 0000000 <br /> TOWNSHIP PERMITS MAY BE REQUIREDI�33t�ar <br /> 0000000 <br />