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 3 <br /> F O <br /> OWNER � TELEPHONE (v51fla-0-SIC-1 SILn �+ <br /> 0 � <br /> HOME ADDRESS I �dllQJ(J(C� � v 0 <br /> EMERGENCY/FIRE NUMBER !9314 ROAD NAME/ jb`'� <br /> LEGAL DESCRIPTION(see tax receipt) C a N'a�f„p�L ar14 ` V /S //S V <br /> `1 C0 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ 0 <br /> TYPE OF PERMIT(S): Q <br /> c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> H <br /> STRUCTURE/ADDITION USE: & to 0 <br /> ome/Cabin; Commercial Business; Bedroom; Deck; etc.) rn <br /> m <br /> BUILDING CONTRACTOR: Eu <br /> C <br /> CD <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. <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> 'i1 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m 'o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <br /> NORTH(N). U) o <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. I 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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS (n <br /> MUST BE SIGNED AND DATED BY THE OWNER. v 'o <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o C� <br /> CONDITIONS OF PERMIT: �f <br /> 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 <br /> SETBACK AREA. <br /> 5. <br /> N N 0 O n C. m <br /> 6. cy " off 3 <br /> m <br /> —_Z CMD <br /> v, m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I o <br /> recognize C 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- y O <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 m <br /> providing in this app icatio I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person t hav ccess to the jlbove des ribed premises at any reasonable time for the puppose qf inspection. -n <br /> CD : <br /> CD : <br /> Fn <br /> SIGN HERE <br /> (signature of owner or�building <br /> .,contractor) (date) <br /> ZONING ADMINISTRATOR \l 1/Y) 1 IC.YI IIG�o�� 469 <br /> koo 40 49 1.4 N N V1 N N 01(T <br /> lT (T O fT fly O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED \'- <br /> 'vv, /6 0 0 0 0 0 0 0 <br /> \4 <br />