Laserfiche WebLink
n 7 <br /> 13 '�~:`County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o <br /> APPLICATION FOR LAND USE PERMITS w 3 <br /> ° <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work <br /> z <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- 3 a <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other = o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. H °' <br /> OWNERpvaq <br /> TELEPHONE o v M <br /> HOME ADDRESS .-e f Wn <br /> EMERGENCY/FIRE NUMBER c� ROAD NAME E v 1p <br /> clasee) <br /> LEGAL DESCRIPTION (see tax receipt)S, y,4 t` rS6^ Y4 f &_i �4 IC40 <br /> CONTRACTOR , o <br /> M <br /> o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION 5 �- <br /> N O <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a <br /> STRUCTURE/ADDITION USE: EAT-a Pcr- r r F <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> 0 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> -n p C <br /> T Z C <br /> 1. All required dimensions or distances to be shown or drawn to scale. FL <br /> m o <. <br /> 2 .Show the location and size of all existing buildings (EB)and all new buildings(NB) and indicate y. <br /> North (N). m o <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. 2 <br /> 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and all distances to buildings, <br /> 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 must be <br /> signed and dated by the owner. 1,40 <br /> J <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> N <br /> O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <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 Z <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> 6. <br /> Ulrn _0rnr- D <br /> < N : . <br /> f 7 <br /> w O O <br /> 9 T� <br /> 8. o <br /> Oi <br /> ZM <br /> I declare that this ap lication (incl ng any accompanying schedule) has been examined me and to the best of my �� - ` m <br /> knowledge and belie 't is true,correct and complete. I acknowledge that I am responsib!o4or the detail and accuracy of a <br /> jQ <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <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 f1 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 <br /> authorized person to have access to the above descri d premises at any reasonable time for the purpose of inspection. T ; m m <br /> i <br /> SIGN HERE - <br /> N; <br /> ate). i <br /> f r� i <br /> na re of owner o g c ntrac or) I " o <br /> P,�. <br /> I i <br /> ZONING ADMINISTRATOR IgJ <br /> rV1Ut0 VINjlcTnNN(POn m <br /> TOWNSHIP PE ITS MAY BE REQUIRED OU 15 to 0 0 0 0 0 0 o m <br /> 00000000fA <br />