Laserfiche WebLink
C cv- ; <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v c) z <br /> APPLICATION FOR LAND USE PERMITS . 4 <br /> r <br /> OWNER V t' M TELEPHONE s�- / S�5 7 <br /> HOME ADDRESS 1e 7-e PS/ Q1 <br /> 1 mk/j- to <br /> -- S8�`1 .5 Pel 77 7 7 <br /> EMERGENCY/FIRE NUMBER ROAD NAME 'f \ <br /> L <br /> LEGAL DESCRIPTION(see tax receipt) )fe 4 �v v r�t� l J 1la 1 w <br /> m <br /> n <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE 'S ADDITION <br /> n <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> y <br /> STRUCTURE/ADDITION USE: fir � <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) -I <br /> T <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ^, <br /> x w <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) p <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T <br /> v <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m j <br /> NORTH(N). C o 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 3 <br /> . <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, <br /> STREAM OR RIVER. z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- at Ico <br /> INGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IFA 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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 2 c I <br /> o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. 5 - <br /> n <br /> 90 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z .. <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT V1 I <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 THE OHWM OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> 6. 3 a3F � ; <br /> n <br /> 7. Z 'yoom �m <br /> o i ZM .� <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my I i C) <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m ? E C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CL <br /> 'm i i m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- E E E p <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 <br /> providing in this application. I agree to Permit county officials charged with administering county <br /> ordinances or other ,f°, <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. <br /> m : <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR � 1 1(n Flain <br /> VIN <br /> 01N CA <br /> N NNN(7 <br /> VI Vt O N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 0 <br />