Laserfiche WebLink
Burp,,ett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -U O Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N 0 <br /> f /' N <br /> OWNER TELEPHONE <br /> HOME ADDRESS `�' �C� / /VQcL100ft /e �'�'� /7AM lolkCeI / )' 6J 5-30+ v o m 9 <br /> EMERGENCY/FIRE NUMBER ROAD NAME Rd. <br /> LEGAL DESCRIPTION (see tax receipt) L d� CD <br /> 0 <br /> � Cn �. <br /> 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION �} <br /> v <br /> a <br /> Vl <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION USE: Iv' <br /> (Home/ abi Commercial Business, Bedroom, Deck,etc.) 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. T <br /> O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OT cL <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). N 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 1 3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, W Z <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ° <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. N I <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS (� <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 BE 0 <br /> ISSUED. <br /> i <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ' ] <br /> ISSUANCE. l (J <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. U, <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 PERMITTE 1 1 <br /> 5. S�-f-�YUCr�U o �p �tQ^S� /�,U �ItiSL tV1�L7�^ �iEnaStc•� �(.� f7C/r� 61^ <br /> 6. Sl ru cx�t�a t'' {v be vy A-5 pal~ p (<e 3 /^✓�ltiin�ii��j/__ 0 n m <br /> H� / U m a m �c .'O <br /> v m c w 0 3 3 <br /> 7. o WC 00 fob <br /> : : ;D <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my L7 c p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of im c c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize i m m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <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 m <br /> authorized person to have access to the above described premiseat any reasonable time for the purpose of inspection. -n <br /> M : <br /> 2 A4 n� <br /> P/- <br /> m <br /> SIGN HERRI 1y a, ` c -/ 3i— 9� <br /> ture f o er r building contractor (date) <br /> ZONING ADMINISTRATOR . . . . . . �+ <br /> a �n 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 <br /> 00 <br />