Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 0 eoo4z <br /> ill 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> o <br /> OWNER ' Sh ( (-)je -POSSM TELEPHONE <br /> m <br /> _ Ir <br /> HOME ADDRESS p'� 5 �(�� ��.� ����� �� � �� <br /> r � <br /> n , 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME DU fl ha,n L Ke <br /> U <br /> LEGAL DESCRIPTION(see tax receipt) ovi Loo �— 0 7" <br /> 0 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION C ' <br /> 5 <br /> m <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION___L <br /> *02 <br /> STRUCTURE/ADDITION USE: <br /> U <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) M 3 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m S iZp <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). H c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m a <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- <br /> INGS,ROADS,LAKE, LOT LINES. Q <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. a` <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 1 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. m o SJ gJ <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q S DQ 00 <br /> ISSUED. 1 i <br /> Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> Q <br /> P <br /> CONDITIONS OF PERMIT: w <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I �1 <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> z - 0r,- 0 0 -0 <br /> 6. n o <br /> gt c� <br /> 7. Z : <br /> o <br /> fn: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ? ? ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m c <br /> a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ' m m M <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <br /> m <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 m E <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ; a <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> m : <br /> o : <br /> H <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR 11(11 I'am L <br /> N 0 <br /> NNNNN <br /> N UI N N UI UI <br /> U UI O UI UI O O <br /> 000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED c 0 0 0 000c <br /> 0 <br />