Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N O <br /> C l <br /> � <br /> / <br /> OWNER " / TELEPHONE (�� 15`1 Q� /✓I/(IQf�t !]Mdr C�NN� - • S�O ��ILLV� 0 <br /> HOME ADDRESS <br /> oar (// LQa ljD Q ���/9 9 <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME LuhS•yJ'4.pt Dy- Lj t T <br /> l /7Z ) 1 <br /> LEGAL DESCRIPTION(see tax receipt) —q— Q <br /> (Y/U -f ��9 SRS�f•,q +/�l50 c. <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ P`RIW',CSJ/ ,� CO 0 <br /> TYPE OF PERMIT(S): -, (( �� c <br /> FILLING/GRADING ❑ CAMPING UNIT SU IVISION N <br /> N M <br /> STRUCTURE/ADDITION USE: ��� o <br /> (Home/Cabin; mercial Bu ness edroom; Deck;etc.) m <br /> o f1, <br /> BUILDING CONTRACTOR: <br /> v <br /> N <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> x N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o 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 ry <br /> NORTH(N). y o� <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m c� 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF v i .Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(VIS,SEPTIC TANK(ST)AND DRAINFIELD(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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 'c o <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a <br /> NEEDED. a �I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. �1) <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. r� <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. ;avnr o � ov <br /> � m m <br /> 6. 8.4 3 0. `r-ae <br /> .0 : N C N a o 'S- <br /> 7 <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my a,c p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of c S <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize N m <br /> MU <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other i m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. -n <br /> o : <br /> o : <br /> SIGN HERE <br /> ( gnature of ntkr r buildin cont r (date) V <br /> ZONING ADMINISTRATOR N40 <br /> N(n NN n+fn <br /> N O0 !h 0 <br /> T NSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 <br /> 0 0 0 0 0 0 <br />