Laserfiche WebLink
Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator ro z <br /> APPLICATION FOR LAND USE PERMITS . ° <br /> OWNER -7/.S' <br /> R/ JeJ„ � TELEPHONE j�sy.-� 63S 6�o e a ,Qj <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION <br /> 5 6CC T3 9 .c'/�/�/ <br /> SINGLE FAMILY DWELLING ❑ GARA /ACCESSORY STRUCTURE ❑ ADDITION ❑ STAI S ❑ o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECKA <br /> STRUCTURE/ADDITION USE: `, <br /> z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) o ° <br /> G <br /> BUILDING CONTRACTOR: 0 L(/ <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT P NS n J <br /> WILL BE RETURNED. <br /> _ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) 0 2. <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/STRUCTURES (EB)AND ALL NEW <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, th <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) �Jo <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK ZZ B <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. n, ' <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTA CES d� o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. 5' <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. d (1\ o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., HE <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE W ENNEEDE <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: w ;1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. z O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n 90 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER III' rT` <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE 0 LY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. RaggM <br /> 1 declare that this application d coo(including any accompanying schedule)has been examined by me and u the best of or anon d a <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information <br /> contained in this application(including any accompanying schedule)and I further declare that I recognize that this Information 1 <br /> am providing will be roiled upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I further accept all N <br /> liability that may be a result of the County of Burnett relying on this information I am providing in this application. I agree to o g tro' <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above- o <br /> described premises at any reasonable time for the purpose of inspect on. E v,c <br /> H <br /> OWNER'S SIGNATURE L^ * v �� 07 ky S R O <br /> oro . uy c � 2 <br /> (date) <br /> ZONING ADMINISTRATOR M.4 M <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE w o o <br /> A4 i-?11�,r- <br /> y6-1)'s-6? <br />