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 < c <br /> N � N <br /> l7 C <br /> OWNER �� `'��� / ) eK,,,.4 TELEPHONE O <br /> MAILING ADDRESS 6,5t-7 VLAac t fr)10 V 61ul I ;t <br /> PROPERTY ADDRESS y —15 nAn \ n <br /> Q <br /> LEGAL DESCRIPTION o <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION STAIRS 0 <br /> TYPE OF PERMIT(S): t—� <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK❑ <br /> STRUCTURE/ADDITION USE: 3 O d IeV e—( — 0 3. <br /> (Hom Cabbiin; Commercial��Busi'n/ess; Bedroom; Deck; etc.) z <br /> BUILDING CONTRACTOR: L.Irl^ ITL C K(hA n — c4 o�� &� —1'1 L16(�C in o <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS1'0� <br /> WILL BE RETURNED. <br /> O ' � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. r] <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW C F <br /> BUILDINGS/STRUCTURES (NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). B <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDING(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK o 0 <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 DISTANCES <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> S. 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 ti <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. —7 <br /> IQ) <br /> NOTE; NG/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDS 00 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n G <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> SETBACK AREA. PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER b 0 <br /> 0 <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. VI <br /> 7. <br /> I declare that this apPliwtlon(Including any accompanying schedule)has been examined by me and to the best of my knowledge z � c a <br /> and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracyof all Information R ^ <br /> contained In this application(including any accompanying schedule)and I further declare that I recognize hat this Information I 3 0 '.g 'e <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all v w r <br /> liability that may be a result of the County of Burnett relying on this Information I am providing in thls application. I agree to <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- <br /> described premises at any reasonable time for the purpose of Inspection <br /> >_- <br /> P-N—Ng <br /> y <br /> 5 A �$ Rf <br /> n <br /> .. <br /> OWNER'S SIGNATURE � �T_ a <br /> ` (date B_ g y <br /> ZONING ADMINISTRATOR � n <br /> U ii e_ao '17 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> a Ul: <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE � p' <br /> 1.+ O f9 N Vwi <br /> to O U H O <br /> �y <br />