Laserfiche WebLink
Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> .. r <br /> rn o <br /> N <br /> C <br /> N <br /> OWNERCL <br /> r' TELEPHONE _� ' _ � Q , <br /> HOME ADDRESS <br /> 1 m <br /> EMERGENCY/FIRE NUMBER ROAD NAME �!Y/ Ge -,;P A 4, <br /> LEGAL DESCRIPTION(see tax receipt) (J L a — / J— �D —� ��( �l Ul � <br /> DWELLING/BUILDING 12 GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ N <br /> CN\ <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ C�AMPING UNITT ❑ SUBDIVISION ❑/ 5. <br /> STRUCTURE/ADDITION USE: 1)1? E] <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) m Ml <br /> m <br /> BUILDING CONTRACTOR: <br /> v <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. T <br /> O <br /> !A O <br /> C <br /> ^� Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m n <br /> 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. ° <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS,ROADS,LAKE,LOT LINES. I <br /> S. 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 02, <br /> MUST BE SIGNED AND DATED BY THE OWNER. I 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Cr <br /> NEEDED. a <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> , <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q ' <br /> ISSUANCE. Q <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 THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. _AGS � D 7—yQ <br /> �jL.yj' /C`'cac zw <br /> `G 3 C W JC—00'., qtr <br /> 7. <br /> a m <br /> I declare that this application (including any accompan schedule) has been examined by me and to the best of my ti C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ? n E <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize n, 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- <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 m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> CD : <br /> M : <br /> SIGN HERE <br /> (signet e o (date) \: <br /> ZONING ADMINISTRATOR <br /> to <br /> V1 <br /> wtnwNL"P 0 <br /> N N N <br /> (T (71 O UI(T O <br /> O O O O O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0000001 <br /> 00000 <br />