Laserfiche WebLink
Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o o <br /> APPLICATION FOR LAND USE PERMITS 3 < <br /> ^' <br /> y 0 O <br /> �n 1 D -y / G N <br /> OWNER n-yI �( l I i 2 r �' 't n s b YI TELEPHONE S - a b 0 ' of Q bO o <br /> MAILING ADDRESS ) �� <br /> 0 <br /> PROPERTY ADDRESS 7 y a 6 © I S Qyl <br /> PC-{, sA) '5 iv S665- <br /> LEGAL DESCRIPTION(see tax receipt) J P t 40 S O u' <br /> (o m <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ❑ y o <br /> TYPE OF PERMIT(S): c o <br /> FILLING/GRADING qAMPING UNIT ❑ SUBDIVI <br /> a <br /> STRUCTURE/ADDITION USE: - o <br /> (Home/Cab) , Commercial Business; Bedroom; Deck;etc.) Cn oJA <br /> BUILDING CONTRACTOR: <br /> m I <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN SY,X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n - <br /> O <br /> M H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> n n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> In <br /> v Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m S <br /> NORTH(N). C 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 Z <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. <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. a <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN v� o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �1! <br /> ISSUANCE. I <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. V <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 2 B CD � <br /> (D C <br /> 7. Z fn W 0 <br /> -n <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Cn A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d 0 v C <br /> a : cn : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize (D -- � <br /> O : m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 0 <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 o <br /> authorized Parson to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> T o : <br /> \\ CD <br /> m <br /> SIGN HERE <br /> CL : <br /> (signature of o or buil ontractor) (date) <br /> ZONING ADMINISTRATOR <br /> EA fA EA 6A + N <br /> N N N N O O <br /> (n0 (n fn00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />