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 2 3. <br /> s <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 in accor- <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other - 2.o <br /> applicable County Ordinances and the laws and regulations of the Stateof Wisconsin. <br /> ng/ 7 y <br /> TL <br /> OWNER �r 1 YI[ ] n nt e_t' TELEPHO 17��� L Z v % <br /> lA v <br /> HOME ADDRESS 'l I r 1 O / ' I p ( id � ed ��('(,lJ )_(L f q W4- <br /> EMERGENCY/FIRE <br /> .E- <br /> EMERGENCY/FIRE NUMBER �l?I/ 1 i1C• ROAD NAME (/ '/ <br /> S Y <br /> LEGAL DESCRIPTION(see tax receipt) A' {.� �i 0* NW <br /> r) Y 5t X Tu) 3gi wy O N / <br /> CONTRACTOR 'V N Y LN / I (j) <br /> 0 <br /> o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE__'LADDITION ii' <br /> N o <br /> o l.nL <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> - <br /> Z v <br /> STRUCTURE/ADDITION USE: ()Y!,�4 <br /> (Home/Cabm; Commercial Business; Bedroom; Deck;etc.) <br /> r <br /> 0 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> O 3 <br /> 11 P N <br /> 1. All required dimensions or distances to be shown or drawn to scale. n o n <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings (NB)and indicate mZI <br /> y: <br /> North (N). y <br /> 3. Show dimensions in feet of the following: (a) building(s) to all lot lines, (b) building(s) to centerline of m <br /> road, (c) building(s) measurement to the ordinary high water mark (OHWM)of lake, stream or river. lr <br /> 4. Show the location of the well (W), septic tank (ST) and drainfield (DF), and all distances to buildings, <br /> roads, lake, lot lines. U <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 must be <br /> signed and dated by the owner. y <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- a <br /> FORE A PERMIT CAN BE ISSUED. 81 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 2. �•v IJ <br /> CONDITIONS OF PERMIT: o <br /> N / 11 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT W <br /> ISSUANCE. 00 <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. D <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> F <br /> 6. <br /> FM <br /> 7. m mg� °' Cysg' 7o <br /> Z f TI`Z <br /> 8. V <br /> FA: _ <br /> c�2 i i m <br /> » • D <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my o <br /> j w ; m <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of t7 <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize '• <br /> o , o ; <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to i <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Information Iam p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other i4 `• <br /> 3 E x : <br /> authorized person to have access to the v9 describe remises at any reasonable time for the purpose of inspection. m m <br /> N N <br /> SIGN HERE <br /> (signature�t owner or bul ng contractor) (date) <br /> `� b : <br /> o <br /> ZONING ADMINISTRATOR (YlIC�c�l1 <br /> L'a T <br /> N N <br /> TOWNSHIP PERMITS MAY BE REQUIRED (TNm <br /> N P v u o v, N Ppm o m <br /> 0 0 0 0 0 0 0 0 N <br />