Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 o <br /> APPLICATION FOR LAND USE PERMITS CD 0 <br /> 3 <br /> 57 <br /> 57 0 <br /> N <br /> OWNER TELEPHONE N O u F o <br /> m <br /> m <br /> HOME ADDRESS } Z S 16 S �/G TfLw n �' () C-lLw� SBv2w Q , <br /> O <br /> s y �yO m <br /> EMERGENCY/FIRE NUMBER „ 1 L5 r. ROAD NAME 4 r 1 <br /> y, b'7 LI SS ro <br /> LEGAL DESCRIPTION (see tax receipt) S I S <br /> e A o L� 37 -tit 2 m <br /> ® t3 � o t E o LeT `fsi <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION PRIVY .V a ti o <br /> TYPE OF PERMIT(S): 1J' c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ °—°' 1 <br /> STRUCTURE/ADDITION USE: l A4 N <br /> 0 0 <br /> ( ome/C in; Commercial Business; Bedroom; Deck;etc.) <br /> U <br /> BUILDING CONTRACTOR: n <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n3 W <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p m p <br /> ,n o <br /> n v z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A <br /> r7 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m CD <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 3 <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. o <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. v l <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> � F <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a o <br /> NEEDED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ' <br /> ISSUANCE. O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 1 <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. 0 <br /> 5. lS- <br /> / DVD £ m <br /> 6. l� ID 3 a � 0 aCD ;Uv C m . o E_ <br /> 7. Z : mo �<o <br /> o 'n m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ` C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n 0 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize " - m <br /> m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> v <br /> G) <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 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m <br /> m <br /> SIGN HERE <br /> (sig ture of own or uilding contractor) (date) <br /> ZONING ADMINISTRATOR /Y1 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />