Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o° o <br /> APPLICATION FOR LAND USE PERMITS y. s <br /> / J 7 <br /> CL <br /> OWNER -e '21 -)'A 5 L rA 'A' �j L TELEPHONE �la- �f ;2 J- J .2 4'b/ o <br /> ss y�sr <br /> / o <br /> HOME ADDRESS cJ ,2 O `�p f yyl ..Q S f�(j 2 j�U-4e, n4 / ?1 -0a�oo4e$ ii/J/ <br /> EMERGENCY/FIRE NUMBER .2 51c2 ROAD NAME <br /> 1 <br /> $S <br /> LEGAL DESCRIPTION(see tax receipt) 0 0 _ / / - o3 — ,7 7/or y/ 73,jw& w u <br /> 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITIOn <br /> N <br /> SANITARY— X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> _ d <br /> STRUCTURE/ADDITION USE: f�_ n <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 3, <br /> ILLEGIBLE PLOT WILLBE RETURNED. (fi � 00 H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW c <br /> O ii <br /> ?+ a z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m io <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). W <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ° <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. 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. 0 C�) <br /> O � _ <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q !a 1 <br /> ISSUED. V✓ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o O <br /> CONDITIONS OF PERMIT: <br /> lI� <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. Q, <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 11 <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. D p m <br /> CD3 aN y <br /> 6. O nl C N o > i <br /> 7. <br /> ? ' N : x <br /> _rn : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 6 a C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o a <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize pP f 9 Y ) g p� m 1° ' m <br /> m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 cl�n '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. T <br /> +ERE d``09(0 <br /> (si at a of owner or build g contractor) (date) <br /> 'TOR 40'A <br /> in o cNn M o <br /> -"'13 PER MAY BE REQUIRED �0 0 0 0 0 <br />