Laserfiche WebLink
C.zyp <br /> Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Adminis r or U o <br /> APPLICATION FOR LAND USE PERMITS 4 <br /> l� <br /> OWNER ma/ TELE/PHONE <br /> HOME ADDRESS a r' 8/ k I Rif w �4 S�f r/� S 0 <br /> ani ��/a r n� J�h � �: <br /> o <br /> EMERGENCY/FIRE NUMBER ROAD NAME �� yp <br /> LEGAL DESCRIPTION(see tax receipt) G U 1 C f� V �� ��3� y <br /> I � <br /> X <br /> y o 7\ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE�ADDITION C ' <br /> c <br /> L <br /> N1 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION � �.J <br /> y ^ W <br /> p / ID V) lJ <br /> STRUCTURE/ADDITION USE: )</Ce <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) � <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. nt <br /> M i"a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 4_ <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE �J <br /> NORTH(N). <br /> n <br /> f \1 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m V 3 <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. 64 Q <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 o <br /> v � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. w <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z I <br /> CONDITIONS OF PERMIT: c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ' I <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 /> e�Mz . m m �pa a -0 <br /> 6. <br /> 91 <br /> 7. : w ;0o : <br /> =y: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my g ? 'Co <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize W 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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m ; <br /> authorized person to love ae ess to the above described premises at any reasonable time for the purpose of Inspection. <br /> n : E <br /> o : <br /> SIGN HERE <br /> (signore of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR vim �l . . • • • . " <br /> "4040444040 <br /> N N UI N N UI UI <br /> UI UI O UI UI O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />