Laserfiche WebLink
IN COY <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator Cn w m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 3. _ - <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for thin <br /> � y <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- 3 <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with a I other - o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. y m <br /> A o <br /> o F <br /> OWNER �� e TELEPHONE)1<_ ? _-3 <br /> ,Ouau m "c7 <br /> HOME ADDRESS �a I ilk -l/it� .� <br /> EMERGENCY/FIRE NUMBER _ / I ROAD NAME f <br /> LEGAL DESCRIPTION (see tax receipt) Rj a,k. <br /> �� T3)/U, C r i !w' F� <br /> CONTRACTOR S <br /> , � o <br /> o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE-k—ADDITION o <br /> y r <br /> 0 <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVIS N <br /> Z o <br /> STRUCTURE/ADDITION USE: Q f�J i0 G L 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 OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> m 9 rn <br /> 'n o a <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 y <br /> North (N). w W <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerlir a of m <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM) of lake, stream or river. <br /> 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and all distances to buildi rigs, <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 mut be W <br /> signed and dated by the owner. v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION E E- ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> 2.o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW, <br /> CONDITIONS OF PERMIT: a <br /> N I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF FERMI rs <br /> ISSUANCE. J <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 FHE — <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED.® OC <br /> 5. - ji pmp �fYCcess �2c ow LA�� $<de Ir A1< � � (,4 d e- <br /> 6. - p4j�o /nil <br /> rn > Do -0 <br /> 7. o, m _u co <br /> a �.� am if m <br /> M <br /> Z M <br /> £ '0 <`2 -4 <br /> y <br /> 8. o - m <br /> o : ate : C <br /> m m M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the bet of my ' L) <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and acc rat of m <br /> 9 P g P Y <br /> all information contained in this application(including any accompanying schedule)and I further declare that I re ognize <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whet h r to is- ' <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this informal on I am n p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances r other 3 <br /> authorized person t pave access to the above described premises at any reasonable time for the purpose of Insl iection. m ; 1 ; H <br /> A N <br /> A <br /> SIGN HERE 17- 192 i " i <br /> N <br /> (al of owner o ullding contractor) (date) o <br /> ZONING ADMINISTRATOR t A o <br /> vl <br /> ����: � n <br /> N N o N U in <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 6 6 0 ' o 0 o m <br /> 0000 000f/1 <br />