Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator " Y o o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> y O <br /> - Z y <br /> OWNER <br /> .'c hard C I r�N IJQ'-1 TELEPHONE <br /> m <br /> HOME ADDRESS ZS <br /> o � <br /> EMERGENCY/FIRE NUMBER 2'L ROAD NAME <br /> I , <br /> LEGAL DESCRIPTION (see tax receipt) {� 1 w <br /> DWELLING/BUILDING ❑ P 0- Z�' <br /> GARAGE/ACCESSORY STRUCTURE I,t~I ADDITION ❑ PRIVY ❑ U) <br /> c <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �' <br /> �RY <br /> STRUCTURE/ADDITION USE: K)0i f� G 'P2� � <br /> p ` (Home/Cabm; o merclal uslness; Bedroom; Deck;etc.) to <br /> BUILDING CONTRACTOR: <br /> M <br /> I <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) On a <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 1 <br /> O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a \ <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c V <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q <br /> ISSUANCE. /moi <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. n <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AR A. / ,/, <br /> 5. �, n /1 Q C,��� �� z v r v <br /> 0 p o o <br /> n . m % ?; fD ag m <br /> 7. c y <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> `° `° ' 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 premises at any reasonable time for the purpose of inspection. -n <br /> m : <br /> CD <br /> SIGN HERE <br /> (signature o owner or ding c a tor) (crate) <br /> ZONING ADMINISTRATOR Q ��—� , 40 <br /> N NN N NUI 0 <br /> U 000666 <br /> N O N U f 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 0000000 <br />