Laserfiche WebLink
& co"* <br /> Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator c o <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNERP�P�SL dVy)S TELEPHONE �6� 7 �o� 0 <br /> / , <br /> HOME ADDRESS .? TrIA/ S y 96 �- �N� <br /> /� <br /> EMERGENCY/FIRE NUMBER a 7�/� ROAD NAME �)^Cll IS C✓/e4' /YX <br /> LEGAL DESCRIPTION(see tax receipt) �C/ � y�/,SY�f $��,3�5 -739/x- <br /> / cr <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION <br /> LL <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> n p � N <br /> STRUCTURE/ADDITION USE: /Urn /"i F ' " Xy - - <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR In W <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 w <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) A Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m S 'A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C .. n <br /> NORTH(NN � o <br /> 3. SHOW D M)ENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 'a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> 0 <br /> STREAM OR RIVER. <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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS W <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BECr <br /> ISSUED. O <br /> z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q <br /> ISSUANCE. G <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,cRIIVER UNLESS SP/F,��I�FICALLY�P.E/-RMITTTEED.& <br /> 5. <br /> a CL U0 <br /> a <br /> 6. <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ZS c ` 10 <br /> knowledge and belief it is true,correct and complete. I 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 M <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m : , <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 E <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. <br /> � JN m . <br /> SIGN HERE date) IN' <br /> gn re of own r or building contractor) ( <br /> Q, <br /> ZONING ADMINISTRATOR 40 `, <br /> N N° N <br /> O O OO G <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 <br />