Laserfiche WebLink
Burnett County 7410 Co. Rd. H, No. 102, Siren,WI 54872 Office of Zoning Administrator m - o 0 <br /> APPLICATION FOR LAND USE PERMITS d 3. _ Fo TO THE ZONING ADMINISTRAT R: The undersigned hereby makes application for a Permit for the workdescribed and located as show herein. The undersigned agrees that all work shall be done in actor-dance with the requirements oft a Burnett County Land Use Ordinance,Sanitation Code,and with all other <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. N m <br /> o <br /> OWNERr - ` TELEPHONE /_ / h 2 S Z3�� O f�n <br /> HOME ADDRESS17 'V o N 5,7- -6.Sy7 <br /> U1 (gEMERGENCY/FIRE NUMBER ROAD NAME <br /> s <br /> a9-ZG z9/ 7{1 tv 4 <br /> LEGAL DESCRIPTION(see tax receipt ^y/- /4 g. -0 0 _ a A'Tp W W SB \) 1 <br /> V <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLINGIBUIL DING ✓ GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> N <br /> o <br /> SANITARY PRIVY ILLING/GRADING CAMPING UNIT SUBDIVISION <br /> Z ° <br /> STRUCTURE/ADDITION USE Plz-/V Q� <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> r- <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) z 0 <br /> O 3 <br /> m 'R rn <br /> 1. All required dimensions or distances to be shown or drawn to scale. n o <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings (NB)and indicate m <br /> North (N). C ; x, <br /> 3. Show dimensions in feet of it a 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. <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. <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. m <br /> i g <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE A PERMIT CAN BE ISSUED. (� , <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. T <br /> CONDITIONS OF PERMIT: o <br /> a. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ? <br /> PERMITTED. D <br /> 4. NO STRUCTURES, INCLUD NG RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE (� , <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. I}� <br /> 5. <br /> f <br /> 6. <br /> rnrn"om DDOy <br /> 7. x o. 0 M0 8 � f <br /> m $.� Ram »�= ft1MM <br /> =• < H' Z ai pMo ro 3 <br /> moE m,2E : 1 <br /> D <br /> o <br /> I declare that this application (includi g any accompanying schedule) has been examined by me and to the best M <br /> of my m <br /> knowledge and belief it is true, correc and complete. I acknowledge that I am responsible for the detail and accuracy of �;^ �;E O <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 w II 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 o: p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 <br /> authorized person to have access tote above described premises at any reasonable time for the purpose of inspection. <br /> m <br /> SIGN HERE,! <br /> (signidum of owner oor,building contractor) <br /> ZONING ADMINISTRATOR II c4cal- <br /> i <br /> TOWNSHIP PERMITS MAY BE REQUIRED o . N c N pl p o m <br /> 00000000 <br /> 0 0 0 0 0 0 0 o N <br />