Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 64872 Office of Zoning Administrator -U o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> N 'Y <br /> C <br /> OWNER e e,� F I TELEPHONE 715 a-as m <br /> HOME ADDRESS I( t) M2 yL ' ttale+';C- <br /> r � <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) L l 1 0S � 3 <br /> C <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION <br /> CL <br /> 5. <br /> w <br /> SANITARY PRIVY FILLING/GRADING CAMPINGUNIT —SUBDIVISION 0 <br /> //-- M!l)me, CA <br /> STRUCTURE/ADDITION USE: &)gyLp / 1 -u,lS <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) � <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR m ` <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <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 o 'A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m J) v 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, l Z <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a <br /> ISSUED. <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. <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,RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. X o0 0T <br /> C a <br /> tm <br /> 6. 9CMNoNE <br /> Z : 00 <br /> 7. 0 : <br /> m <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my I� A <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of � ' 0. <br /> all information contained In this application(Including any accompanying schedule)and I further declare that I recognize f° m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m v <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 access to the above described premises at any reasonable time for the purpose of Inspection. -n <br /> m : <br /> m : <br /> SIGN HERE <br /> (sig"na�re o�f ownJer/or building conVactor) (date) X�r i <br /> ZONING ADMINISTRAT0 1 1� �C l� l w w w fn yr N <br /> [r!.n NO V7NOO <br /> 000000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 <br />