Laserfiche WebLink
ON COMPUTER/SCANNED ,C}, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 0 o <br /> APPLICATION FOR LAND USE PERMITS . 4 <br /> 0 <br /> OWNER ' l+ U -C/ {,(/., TELEPHONE `J/S Gc�q^ a)i v l I I O <br /> m <br /> HOME ADDRESS <br /> c <br /> EMERGENCY/FIRE NUMBER ROAD NAME 14ai e kqf <br /> LEGAL DESCRIPTION(see tax receipt) .j r r 3. �,\ /P GI/ <br /> n <br /> V! <br /> 0 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION c <br /> n <br /> 5. <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> C0 <br /> m <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 } <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 v <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) 0 � <br /> �+ z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO lm v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OH OF LAKE, ( Z <br /> STREAM OR RIVER. c <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- <br /> INGS, 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 6 i <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BEq <br /> ISSUED. o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Zn. <br /> CONDITIONS OF PERMIT: P <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 SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> 6. 3 n a <br /> � Co5* Z <br /> to C ,2 <br /> 7. Z : w 5at <br /> o : <br /> =y: : In <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my cq p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofCL <br /> m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m ' <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m m E M <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Information 1 am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other CD <br /> 2 ; E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. mCD <br /> , <br /> SIGN HERESY/ • <br /> (signature of owner or building contractor) ' (date) <br /> ZONING ADMINISTRATOR zlTrnPa-n Ow40 <br /> ww«v�d. <br /> TOWNSHIP PERMITS MAY BE REQUIRED " ` ` - 0 0 0 0 0 0 <br />