Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator vim/ 0 z <br /> APPLICATION FOR LAND USE PERMITS . 4 <br /> r <br /> ,/ l N w <br /> OWNER 6N A) � PJ S 0 TELEPHONE +�5 3(67 7 (f,L.n ) 1 <br /> 0 :� <br /> p n _ syZ36 <br /> HOME ADDRESS 6 (D 70 N(�J�/ -7 '7 /I'© 0 X LI 7S 1�aNt 6 Li R, wa <br /> / o � <br /> EMERGENCY/FIRE NUMBER K n 6 76 ROAD NAME Nd/Uc I <br /> LEGAL DESCRIPTION(see tax receipt) P&/ f�yj� sC s ,� 4/ \ <br /> y- /" i <br /> XIn o <br /> TYPE OF PERMIT(S): DWELLING/BUILDINGGARAGE/ACCESSORY STRUCTURE�ADDITION v <br /> CL <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT o'SUBDIVISION � <br /> / to D <br /> STRUCTURE/ADDITION USE: Po rA C/o F_C K — G A 2A C.t_ <br /> Ea <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETER 91 <br /> QO �r 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> 0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) �N ' Q c <br /> T <br /> T ^ Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m �D <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m a3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. o <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. <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. m' c <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q 0 <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: ) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Z <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. <br /> LF <br /> 6. 3a 2Lk <br /> 7. o : F %Q :'m 1 <br /> =cn <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofCL <br /> i m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- p <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 /> m : <br /> SIGN HERE H ' <br /> (a n re of o e r building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> www H <br /> N N U N <br /> N ut O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 <br />