Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren,Wi 54872 Office of Zoning Administrator -o 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 o <br /> io <br /> m <br /> /� m <br /> OWNER l I( % <br /> TELEPHONE l0s> <br /> HOME ADDRESSI <br /> > y <br /> EMERGENCY/FIRE NUMBER G' d / ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) IzI <br /> Cn0 <br /> n <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ y o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUB DI SION El1 <br /> STRUCTURE/ADDITION USE: go m� a � X T� o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> 17r- <br /> BUILDING CONTRACTOR: S e ( JD n l a WS O 0 <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m - <br /> y <br /> DIRECTIONS FOR PLOT PLAN DRAWING-- ERIAL OR TOP VIEW) p <br /> m a <br /> T Z <br /> 'I-- ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m ` 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. o <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 /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED, i 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. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: 0 1 <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. <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 d <br /> SETBACK AREA. <br /> 5 VI' —6/ 1 M. m vDaOv <br /> M . � m m <br /> s. m � � om0Q z <br /> 7. <br /> O � <br /> rn <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my uj c m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m m <br /> C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whetm <br /> her 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 am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to ave accesq,4o the above described premises at any reasonable time for the purpose of inspection. . . '�9 <br /> CD <br /> CD <br /> SIGN HERE <br /> (signature of wne or building contractor) (date) <br /> ZONING ADMINISTRATOR _4� <br /> to cn to to is a <br /> NOINNN l,"K'7r <br /> V1 O Vt un O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 o q <br /> a <br />