Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 0 <br /> APPLICATION FOR LAND USE PERMITS 3 �_ 6� <br /> r \1 , <br /> 41 <br /> o <br /> OWNER -7'1-7 &# �2 TELEPHONE 7�3 7g q Z-L31(o n <br /> HOME ADDRESS L140 3 3v a W <br /> �7l%i09/ -ST 1"t C°UL, IYG73 <br /> r m <br /> EMERGENCY/FIRE NUMBER 1��.� ROAD NAME0 <br /> // ' J /) /v� w i'Pd <br /> LEGAL DESCRIPTION (see tax receipt)L 3 �I f� YI//' / `�`�/ `\ �Cn <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE lYJ ADDITION ❑ PRIVY ❑ G o <br /> TYPE OF PERMIT(S): ✓` <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> �+ < <br /> STRUCTURE/ADDITION USE: !y o rb <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR B. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. �t <br /> O67 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> n o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n Z <br /> o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(N 3 ;bB)AND INDICATE m <br /> NORTH(N). C O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m �l <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 /> f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. T p <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z O <br /> CONDITIONS OF PERMIT: ° ty <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O <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 THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> CD W ° f m <br /> 6. m � 3am0 cD � <br /> -0 N C N N O <br /> 7. Z N O <br /> o T m= N: <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of 0 0 m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ` <br /> CD <br /> that this information I 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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. mm <br /> : <br /> CD <br /> � 1 (D <br /> SIGN HERE <br /> ( gnatur owner or build' contractor) (date) / ^ <br /> ZONING ADMINISTRATOR I�IIJ' <br /> TOWNSHIP PERMITS MAY BE REQUIRED �I <br />