Laserfiche WebLink
Burnett,County"7410 Co. Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator m A o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work <br /> described and located as shown herein. The undersigned agrees that all work shall be done incor- 3 g <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all ther o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. ] <br /> OWNER i0A NA� TELEPHONEd?7 915k <br /> HOME ADDRESS e 19nal H�-k� R s S y 89 3 m �l <br /> EMERGENCY/FIRE NUMBER ROAD NAME al <br /> i <br /> NeR Wr )IeWa and IL o eu 0e1 ✓M <br /> LEGAL DESCRIPTION (see tax receip a)FR'� �-�� 'VJ of S�c�/ / nI ) WN�w 6 <br /> 6C 9..d Fore 1-y Yr [ vrvdRe.e S 3I. Vie <br /> CONTRACTOR o <br /> � o � <br /> x <br /> TYPE OF PERMIT(S): DWELLING/BUILDING�GARAGE/ACCESSORY STRUCTURE" � ADDITION o� <br /> m O <br /> O y <br /> SANITARY PRIW FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION USE: SCCAMq /Ttl 'e ' <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) oov r q GII <br /> r <br /> 0 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE C R <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> x <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) r 3 N <br /> in o S <br /> 1. All required dimensions or distances to be shown or drawn to scale. ?52. Show the location and size of all existing buildings(EB) and all new buildings(NB) and indicate m l <br /> c L <br /> North (N). m — <br /> 3. Show dimensions in feet of the following: (a) building(s) to all lot lines, (b) building(s)to centerlin of <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM) of lake, stream or ri r. �j I <br /> 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and all distances to buildi gs, <br /> roads, lake, lot lines. <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans mus be <br /> xZ <br /> signed and dated by the owner. i <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION E E- <br /> FORE A PERMIT CAN BE ISSUED. N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <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 SHORELI 1E. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 9 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF HE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> 6. <br /> u)m �(nrDDO � <br /> o Ram a Inm <br /> 7. $ m< m Cumin' T� <br /> y < m ; 2mo �m <br /> moi �Zi <br /> Z Fes ; a y: i M <br /> G)� <br /> 8. , m <br /> NE E D <br /> 61 i 71 <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the bet of my m t m <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and acc Aracy of <br /> 00 0 : <br /> all information contained In this application(including any accompanying schedule)and I further declare that I n cognize <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whotl or to Is. o <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Informal on I am <br /> P <br /> In this pplication. I agree to ermit county officials charged with administering county ordinances r other ': 3 <br /> authorized pe to have access tot bove described premises at any reasonable time for the purpose of Ins action. qm �' <br /> 3 i V <br /> SIGN HERE NoRh Z <br /> i1signaldreof ner orbuilding contractor) '(' ' g <br /> ZONING ADMINIS TOR <br /> + 0 0 0 N N <br /> TOWNSHIP PERMITS MAYBE REQUIRED j 9 0 0 0 0 <br /> t� <br /> I <br />