Laserfiche WebLink
o� cVy)'LP <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work � H <br /> described and located as shown herein. The undersigned agrees that all work shall be done in i ccor- 3 UJ <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other - o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. y m <br /> FX <br /> O <br /> OWNER �- / - .�/ TELEPHONE •3 1�� S 2 t et <br /> HOMEADDRESS ,� C -K �'��E S T Lw� 'f (• Ct- < .7 J (.S� t�, <br /> EMERGENCY/FIRE NUMBER S ROAD NAME m , 4U <br /> LEGAL DESCRIPTION(see tax receipt) `�/V( Et✓ 3 <br /> CONTRACTOR <br /> O <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION 0 -r <br /> —7 <br /> " o <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> — <br /> Z 0 <br /> 7� m <br /> STRUCTURE/ADDITION USE: DF C C <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 O <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> m a N <br /> 1. All required dimensions or distances to be shown or drawn to scale. n o n <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB) and indicate m y: <br /> North (N). C ° <br /> 3. Show dimensions in feet of the following: (a) building(s) to all lot lines, (b) building(s)to centerline of m C� <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 buildings, SL <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 must be v <br /> signed and dated by the owner. � <br /> 2 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION B :- <br /> FORE A PERMIT CAN BE ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <br /> W <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 SHORELIN E. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ? <br /> PERMITTED. a <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE T <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. N, <br /> 5. <br /> F <br /> 6. <br /> o c m $ f m <br /> 7. o <br /> Z F J : TZ ? 1 <br /> 8. o _ � M <br /> � : ; m <br /> u �� ; p <br /> of n � C <br /> o : <br /> m m M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my m <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accui acy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 roegnize o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whethe 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 Informatic n I am n <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> 3E <br /> authorized person to have access to the above deet ' ed premises at any reasonable time for the purpose of Inspf ction. m o m <br /> m <br /> al N <br /> Q. al <br /> SIGN HERE <br /> N ; <br /> (signature of owner or building contractor) (date) j o <br /> -FlZONING ADMINISTRATOR p)11 G�3' o ': E <br /> TOWNSHIP PERMITS MAY BE REQUIREDN N N N N U m <br /> O U U t O N N I l t 0 <br /> 0 0 0 0 0 0 0 0 <br /> 0 0 0 0 0 0 0 0 f A <br />