Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ' o° o <br /> APPLICATION FOR LAND USE PERMITS . <br /> r <br /> y O <br /> 41 <br /> C E- <br /> N O <br /> OWNER �N - TELEPHONE /�/J -J —c��� t <br /> MAILING ADDRESS & ' (�! : <br /> o � <br /> PROPERTY ADDRESS ,(,i 3 <br /> a « <br /> LEGAL DESCRIPTION(see tax receipt) PG( N 0,5 A qd/7 ( m <br /> DWELLING/BUILDING ® GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ i, Cn 0 <br /> TYPE OF PERMIT(S): �Na <br /> FILLING/GRADING 1:1CAMPING UNIT ❑ SUBDIVISION El S. <br /> T. <br /> STRUCTURE/ADDITION USE: R 9 X 0 <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) U �1 <br /> BUILDING CONTRACTOR: 42 <br /> J <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81h X 11 SHEET OF PAPER. ANY INCOMPLETE OR In <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> :n v Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). rCp 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m A'V` <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF d Z I <br /> LAKE,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 <br /> BUILDINGS,ROADS, LAKE,LOT LINES. CJ <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 Q 0. <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q ° \ <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: p ' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. nl, <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. �(J <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. Q <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> �SETBACK AREA. <br /> y� <br /> 5. <br /> m W W 0 00 a f m <br /> CD B nm xaT.. 3 <br /> 6. Z yiDoy �'9 :q <br /> 7. OT G M <br /> = m': m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G�c C <br /> knowledge and belief it is true,cor0 <br /> rect and complete. I acknowledge that I am responsible for the detail and accuracy of m � v, <br /> av <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o me <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. o : <br /> CD <br /> SIGN HERE e& CL i <br /> (signature of r or building contractor) (date) n <br /> ZONING ADMINISTRATOR <br /> Q 49,w fA FATN <br /> • N (n Nro <br /> o OI O 01 Oi O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE �Q % <br />