Laserfiche WebLink
-o <br /> Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator CD- o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 0 VNC <br /> N <br /> d <br /> OWNER r r c� �r M TELEPHONE �7 A'� In�i 1.• �F) J o <br /> M O <br /> MAILING ADDRESS3V CQ <br /> r �� <br /> 0 <br /> PROPERTYADDRESS \ <br /> Vq y a y <br /> LEGAL DESCRIPTION(see tax receipt r 0 <br /> DWELLING/BUILDING 21 GARAGE/ACCESSORY STRUCTURE ❑ ADDITION LJ 90 WIN94p SnrN�- W) 0. <br /> TYPE OF PERMIT(S): Y for <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 4islet„t <br /> STRUCTURE/ADDITION USE: P �_ X (fin \ / o / <br /> (Home/Cabin;Commercial Business;Bedroom; Deck,etc.) U <br /> 1 � <br /> BUILDING CONTRACTOR: l 11p,� �i i <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> n <br /> ll 0 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <br /> NORTH(N). O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <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 01 <br /> BUILDINGS, ROADS, LAKE, LOT LINES. l� <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N l�, <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 xR J= <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> v (jam <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. Jl> <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o CSG <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I �' <br /> i <br /> ISSUANCE. (7C <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Q <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..y� <br /> m 0) 0Ca0M <br /> $ 3 a m F° CL CD <br /> m <br /> 6. � c N ^ o S. 3 <br /> Z NCD <br /> o O <br /> 7. P Wiz ' m <br /> W A <br /> - <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j G) cC <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of \ a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 1`” : M , O � <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have acce o he above described remises at any reasonable time for the purpose of inspection. m o <br /> SIGN HERE CL <br /> (signs a of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> r\ N Ln N N O O <br /> O T (T O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />