Laserfiche WebLink
Irl c� <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o° o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> TELEPHONE I � �1 Z ►1�? h q <br /> 5 0 <br /> (� L <br /> HOME ADDRESS a7j She`d {�� •l Viz, 60 <br /> EMERGENCY/FIRE NUMBER ROAD NAME t N� F��NL�p�� c5 <br /> a <br /> LEGAL DESCRIPTION (see tax receipt) �G G, O �p ( 1 1\� O w CD <br /> a <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ I c o <br /> TYPE OF PERMIT(S): Ll <br /> FILLING/GRADING ❑ CAMPING UNITE SUBDIVISION ❑ <; <br /> 0 <br /> STRUCTURE/ADDITION USE: PK L n\A 6 I N = T <br /> (Home/ abin; Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: �R- _r �,h �1 C� C� G fir <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. A uN w <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n ii <br /> ?+ o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE rn o <br /> NORTH(N). N <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m oQ 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS,ROADS,LAKE, LOT LINES. <br /> S. 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. to <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. f <br /> 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 THE REQUIRED WATER <br /> SETBACK AREA. p1� + <br /> 5. See �trtnl�Ltleid- (D CLO <br /> 6. NN O N o <br /> 7. _y: <br /> A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my90 <br /> L7 C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o E <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognize Q <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I a io <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other E m <br /> authorize rson to have access to the above described pren' as at any reasonable time for the purpose of inspection. - ; <br /> m : <br /> SIGN HERE e <br /> (signature of owner or building contractor) (da e) <br /> -F <br /> , <br /> ZONING ADMINISTRATOR <br /> N N O N N O <br /> OO O O O <br /> O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED O O�O <br />