Laserfiche WebLink
Q"Yl C4--kt <br /> Burnett County 7410 Co. Rd.K, No. 102, Siren,Wi 54872 Office Of Zoning Administrator -0 a z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 0 <br /> C <br /> 4 v <br /> OWNER � � �� � —' TELEPHONE � <br /> m <br /> ° <br /> HOME ADDRESS 0 <br /> m <br /> EMERGENCY/FIRE NUMBER ) ROAD NAME <br /> /_ s <br /> LEGAL DESCRIPTION(see tax receipt) / ��� - 9- 7�—� _ d m <br /> r� <br /> DWELLING/BUILDING F-1 GARAGE/ACCESSORY STRUCTURE ❑ ADDITION El PRIVY ElVPRI1 cn 0� <br /> TYPE OF PERMIT(S): X77/ a <br /> FILLING/GRADING CAMPING UNIT/❑ SUBDIVISION L`1 5. <br /> STRUCTURE/ADDITION USE: w// I 11• �(i9 �� / —`�/ ° <br /> (Home/Cabin; Commerciall Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: t� /V � \ )!/{SLP L�///Ci <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR rn 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ° n <br /> NORTH(N). (A p` <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF R <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <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. o <br /> o � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <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 THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. op <br /> ;a� � m <br /> I O� <br /> c�c 3 0.26 ° m <br /> 6. 2d � �' e — •� <br /> S : m CH m or. <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C p <br /> knowledge and belief It is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of \ nLrc <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize . <br /> " 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 premises at any reasonable time for the purpose of inspection. -n <br /> CD : <br /> CD : <br /> 49 <br /> SIGN HERE <br /> (signature owner or building con ctor) (date) <br /> ZONING ADMINISTRATOR w <br /> wwwfnwfn� <br /> N N Ut N N Vt N <br /> OI Ut O ut 01 O O <br /> VTWN'SHIP PERMITS MAY BE REQUIRED x 0 0 0 0 0 0 <br /> Ooo0000 <br />