Laserfiche WebLink
ni <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Adminis rator _U f o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> 42 <br /> s <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work � y <br /> described and located as shown herein. The undersigned agrees that all work shall be done in a ccor- 10 '—'� <br /> 3 <br /> dance with the requirements of the Burnett County Land Use Ordinance, Sanitation Code,and with all other - o `9 <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. y m <br /> 0. t-yy� <br /> OWNER ,t a C- Uu 1 1'1QO 1y TELEPHONE , / - �� 'g o <br /> r. ��/, } rn 550,4 <br /> HOME ADDRESS t3 LQ WQ, 5d GO <br /> VVWW.•ll ll t <br /> EMERGENCY/FIRE NUMBER O O L ROAD NAME ,r <br /> D V 1 <br /> n <br /> LEGAL DESCRIPTION (see tax receipt) <br /> 1J See- �1 7 q o4 1Z1`i ) -To" U� Ov, <br /> CONTRACTOR 2A t) 1) G O TV ST, PI f✓ o <br /> c� o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION <br /> y O <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> — <br /> Z ° <br /> l $ U <br /> STRUCTURE/ADDITION USE: 11 1 i ❑ �� r R <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) <br /> r <br /> 0 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE O <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ,t <br /> O <br /> A <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 3 <br /> 'n P rn <br /> T o n <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(EB) and all new buildings (NB)and indicate m (t I N <br /> North (N). to <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of m I <br /> road, (c) building(s) measurement to the ordinary high water mark (OHWM) of lake, stream or river. -Z K <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildi gs, <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 be10 <br /> signed and dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE <br /> -FORE A PERMIT CAN BE ISSUED. <br /> 2.o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: q <br /> a <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. 70 <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 1 HE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> f <br /> 6. <br /> M g c 0 m <br /> 7. O <br /> ?� 3 <br /> 8. o - <br /> O <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the besil of my <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of N y p <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize i i m <br /> o , 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 n o <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have acces to the above described premises at any reasonable time for the purpose of Inspection. rym ? ? H <br /> N N <br /> H <br /> SIGN HERE V0 <br /> (signator "nor <br /> ror building contractor) (date) <br /> ZONING ADMINISTRATOR wD <br /> fn F»�wtn L9 -n <br /> N N U N N N N <br /> TOWNSHIP PERMITS MAY BE REQUIRED o o ao 0 00o m <br /> 00000080 <br />