Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator `0 C' <br /> z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 7 <br /> N <br /> OWNER TELEPHONE �a() ' �(�6)d-14 n <br /> v <br /> d <br /> /� <br /> MAILING ADDRESS O tJ �ax �l�3 F <br /> PROPERTYADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) <br /> T T !p m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTUR ADDITION ❑ o <br /> TYPE OF PERMIT(S): CC <br /> FILLING/GRADING ❑ CAMPING UNIT ❑1/Sy BDIVISli I <br /> STRUCTURE/ADDITION USE: V / 9 <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) U) l <br /> m Ip <br /> BUILDING CONTRACTOR: '- <br /> m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m 3 3 <br /> O C <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> -n n <br /> Tz <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n �O � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <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 Z <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> f <br /> O J <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ."» o, <br /> NEEDED. M (� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z `I <br /> CONDITIONS OF PERMIT: o <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. �J <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m 3 a m x A <br /> N C y O <br /> 7. o w m <br /> T <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of u O in <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize m o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <br /> E O E <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. 1 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 m <br /> m <br /> o <br /> m m <br /> SIGN HERE d' <br /> (signatur owner or building co a or) o. <br /> (date) <br /> ZONING ADMINISTRATOR <br /> 6 <br /> N <br /> EUi N N fA N) r) 0 N <br /> 00 <br /> (T 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />