Laserfiche WebLink
Burnetf County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator - ' 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> y O YJ <br /> N <br /> OWNER 610 oild' <br /> TELEPHONE o <br /> d J <br /> HOME ADDRESS <br /> 1� lJ/� ' l yrs <br /> ( A lr m <br /> EMERGENCY/FIRE NUMBER / �# Jl( ROAD NAME L&�� <br /> LEGAL DESCRIPTION <br /> ( receipt) <br /> see tax recei <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION IN PRIVY ❑ I a F /Ts r <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> N <br /> STRUCTURE/ADDITION USE: (�/�A La <br /> / (Home/Ca ; Commercial Business; Bedroom;Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m '3_ <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> M p� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). tC/i 0 <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. ° <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. -lJ <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 64 <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. 0 t <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Cr o <br /> NEEDED. �� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o (" <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. GI <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. � <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. SQQ Vct.nA1L /y� ^/yip oI/ (;Do n <br /> CL <br /> 6. 0N o . 3 <br /> a J v mCN � 0 <br /> OD R <br /> / ars �' 0 <br /> — aE m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best-of my C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of 0IF : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- y 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 CD <br /> o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. n <br /> m : <br /> SIGN HER 1-z <br /> (s nature of ner or building contrac r (date) <br /> l � <br /> ZONING ADMINISTRATOR ON <br /> / u, Inou, , o <br /> WNSHIP PERMITS MAY BE REQUIRED l0�� o o <br />