Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -0 / Z <br /> APPLICATION FOR LAND USE PERMITS <br /> 0 O <br /> OWNERQcl/' r1�J�l-CI nil TELEPHONE( J /•j ICosty <br /> / `IfsO <br /> HOME ADDRESS r7 j _ <br /> W <br /> EMERGENCY/FIRE NUMBER ROA NAMEh <br /> 00 -Y/At <br /> LEGAL DESCRIPTION(see tax receipt) '� L1 ) �� N� & 5& d 2 /dp � <br /> W � 0 <br /> Q <br /> / m o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTUREy ADDITION Q <br /> a <br /> 5. <br /> w <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> ca <br /> m <br /> STRUCTURE/ADDITION USE: ra fir <br /> •c � <br /> (Home/Cabin; ommercial Business;Bedroom;Deck;etc.) T <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 H <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) CL <br /> m <br /> Z�_ 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 C _ n <br /> NORTH(N). r/► <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 LAKE, c <br /> STREAM OR RIVER. <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. 1 <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. n <br /> o � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Cr ° <br /> ISSUED. <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. op W <br /> CONDITIONS OF PERMIT: "I <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. ;aM0rn <br /> 6. yop �09 <br /> + r '0n G do M <br /> 9i o <br /> "I <br /> Z : <br /> 7. m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G'S c C <br /> n aknowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of i : A <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o 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 d i <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m i <br /> authorized person to have access to the aboV0 described premises at any reasonabi a time for the purpose of Inspection. T <br /> SIGN HERE f <br /> (si at f nor or Qcontractor) t (date) <br /> ZONING ADMINISTRATOR <br /> 03006 1 <br /> KE <br /> wv�wfnw� <br /> TOWNSHIP PERMITS MAY BE REQUIR 000000 <br />