Laserfiche WebLink
C O O <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning AdministratorOQ <br /> g 3 <br /> APPLICATION FOR LAND USE PER COWNER TELEPHONE 59 <br /> M��t' pat� J <br /> C <br /> (� m <br /> MAILING ADDRESS <br /> C/_f/-a <br /> PROPERTY ADDRESSN . <br /> ✓� (CY ' n <br /> LEGAL DESCRIPTIO11�1 /7 i min <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING)< ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE � y <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIR: FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ ICP / <br /> STRUCTURE/ADDITION USE:h�In Q. <br /> Home/Cabin; Commercial Business; Bedroom; Deck; etc.) (n <br /> BUILDING CONTRACTOR <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. <br /> 6 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) ren <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW m '9 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, v a <br /> AND INDICATE NORTH (N). N 1 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) °o . <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK I <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. p <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES Wj I <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. 'S' <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. d J <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r- <br /> 1. <br /> - <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. (Jjl n <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER NI <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. O <br /> NOT TO BE USED FOR HUMAN HABITATION. 0 <br /> 6. G <br /> 7. $ '� 2 0 0 m c p 7 <br /> a n P 3 3 3 A a F7 <br /> H3 3 3 0 0. 0 <br /> I declare that this application (Including any accompanying schedule)has been examined by me and to the best of my 3 0,2°z <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all $ m <br /> Information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this c, D 9 m <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to i ue a permlt. I <br /> further accept all liability that may be a result of the County of Burnett relying on this Information I am pro 14 In this <br /> application. I agree to permit county officials charged withodpTistrating county or finances or r authorized erson to have <br /> access to the above-described premise�•• -easonabl Imethe purpose of inspection. o 6+ P1 <br /> ' o D00000y <br /> OWNER'S SIGNATU� �.� I `�' n cA a n <br /> f ��r I I 1 L �I/I(.11 ` ate y y o wN N n cn <br /> ZONING ADMINISTRAT o c: o <br /> n c : is n tri <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> It1�/f�lc►neT �e i 6-ami l ti o 0 <br /> O2am4- <br />