Laserfiche WebLink
CCS i2 =� <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v G) z <br /> APPLICATION FOR LAND USE PERMITS 3 ° <br /> r <br /> i N O <br /> nn !� f [� <br /> OWNER <br /> Rr) Q aT.Q u ^.) QiZj p% 1-!� 4 TELEPHONE 6 �y7 S�o2 0 n <br /> HOME ADDRESS ; V w <br /> C <br /> O <br /> `� I ` CD <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> �R <br /> LEGAL DESCRIPTION(see tax receipt) 0) v <br /> CD d <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ESSORY STRUCTURE v V Q o--)!LADDITION o ' <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION w <br /> o' <br /> Cn <br /> STRUCTURE/ADDITION USE: (Uafk <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) 1 1 <br /> -o <br /> A PLOT PLAN MUST BE PON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ROVIDED <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) p.ma <br /> m n C <br /> n m C Z <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 <br /> NORTH(N). c IN 0 <br /> 3. SHOW DIMENSIONS 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, <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- o <br /> INGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <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. o <br /> o I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Cr <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: p <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. t� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY W <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 75 <br /> jJD$, RIVER UNLES- SSPrFIjLLYSPEJ2M�rEg. <br /> 6- ';L<- "M ;o -0 0 r- 0'�!a -V <br /> Lac p9-S ,p4 ��uH 1 71998 cop ` D c <br /> a <br /> 9 m m . o � 3 <br /> �. BURN o i ' <br /> = W m <br /> e <br /> I declare that this application (including any accompanying schedule) has been examined b of my �j c . p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for nd accuracy of c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- Cl <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 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> r <br /> �_-� 2- Sd <br /> SIGN HERE <br /> (s n u e or ul ing contract <br /> or)) (date) <br /> ZONING ADM �TTOR <br /> N NfT NN (n(T <br /> Uf (n O[T U1 O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />