Laserfiche WebLink
Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a z <br /> APPLICATION FOR LAND USE PERMITS h: y <br /> OWNER / I�G�`— TELEPHONE �In _plQ_ <br /> �CDit� � a <br /> MAILING ADDRESS [jig <br /> I T P Rte, Dp.T.�cs�J�y, v1f v � <br /> PROPERTY ADDRESS AS Ane <br /> Pit1ZT OI= Gt VT toT<( t SCGT �,is D TA r- y O� TrLfc e r �Y r, <br /> LEGAL DESCRIPTION o <br /> D y�„a_SZ 5 -�ult'`R GF/A Sf^f i styQt�., Po <br /> TYPE OF PERMIT(S): SINGLE-FAMIL DWELLING ❑ DDTTION ❑ D CK ❑ GARAGE/ACCESSORY STRUCTURE' I m <br /> BUNKHOUSE ❑ S9.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ \ " <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: c Y rr <br /> o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> I <br /> BUILDING CONTRACTOR: <br /> n <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 W X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. <br /> c <br /> DIRECTIONS FOR PLOT PIAN DRAWING: (ARIAL OR TOP VIEW) � <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW <br /> BUILDINGS/STRUCTURES (NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, a W v <br /> AND INDICATE NORTH (N). o �` a <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) N <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES5 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. o <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 Uj o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. a a <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN '- <br /> NEEDED. ti I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELTNE. o � � d C <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Q <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER `r <br /> SETBACK AREA. c V l <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. c <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. G � <br /> 7. > oaro <br /> `� <br /> [declare that this application(including any accompanying schedule)has been examined by me and to the best of my o ,� � � � '� <br /> m : "° <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all rs m ' t✓ P . <br /> Information contained In this application(including any accompanying schedule)and I further declare that I recognize that this > c m N <br /> informatlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I $ ff u " <br /> further accept all liability that may be a result of the County of Bumett relying on this information I am providing In this <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have 0 : O 8 <br /> access to the above-described premises at any reasonable time for the pure of Inspection. m a 8 N 8 S y <br /> OWNER'S SIGNATOR ' .0 m �' L' 8 0 <br /> nVf F.tri f] d 6u6. '+1 <br /> (da ) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> j} T/HIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> 11 1 1 LJ O Vr to 1n <br /> le+4-er p(c'" d up bLI 6en✓�e UUase-1 °I-a-II <br />