Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> r <br /> y <br /> OWNER eae h TELEPHONEo- <br /> u ✓ i o <br /> HOME ADDRESS a� AT 146e, Q� 5 Al �% � /�r/ 9 <br /> _ F <br /> ,3 <br /> EMERGENCY/FIRE NUMBER // ROAD NAME <br /> Sic. !a <br /> 7 Ul P yo !s <br /> LEGAL DESCRIPTION (see tax receipt) e 1 V d 1 ( ovaqer �G <br /> I C <br /> DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ 'Y <br /> TYPE OF PERMIT(S): C ti o' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: l9}y/Q 30 1C (on 40,167 <br /> d Rarer, as a� _y: <br /> o <br /> (Ho /Cabin, commercialusmIV) <br /> Business; B room; ck;;etc. C{y�G( � co J <br /> BUILDING CONTRACTOR: DYYI Q <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Y,X 11 SHEET OF PAPER. ANY INCOMPLETE OR `1) <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n 3 <br /> O <br /> FcQR PLOT PLAN 9fLAVIflNG• (AERIAL OR TOP VIEW) A <br /> O `m <br /> a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. -n-n ? <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m o Z <br /> NORTH(N). C <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. AZ <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO P <br /> BUILDINGS, ROADS,LAKE,LOT LINES. C <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. rr�� <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: o i <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. L <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> ;o 0g > 0D0 -0 <br /> 6. f m <br /> 0 < m j � m a <br /> m � 3amxE � � <br /> 7. m c m `� O S 3 <br /> Z N N O O(O <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of d 0 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 whether to is- m l7 <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 d <br /> providing in this applica ion. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to h e access to the above de cribed premises at any reasonable time for the purpose of inspection. m <br /> : <br /> _ m <br /> SIGN HERE (CD <br /> (signature of owner or bui din ntractor) ate) <br /> ZONING ADMINISTRATOR - <br /> �a <br /> TOWNSHIP ERMITS MAY BE REQUIRED c' <br /> 0 <br />