Laserfiche WebLink
, �Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 'a0 0 <br /> APPLICATION FOR LAND USE PERMITS 4 <br /> OWNER 4ETELEPHONE "' ' �� a <br /> y, % ` / <br /> HOME ADDRESS 7jQ L , !✓J�Ym ,�,�i - a' o 0 <br /> r <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> �1-6-F f3 L&7- (>o C <br /> LEGAL DESCRIPTION(see tax receipt) NAy U� pq !1 )41'f„_ �° _ 1/Q�/ /1iv.l <br /> LY �- rw w�cp / /V T�� 0 4 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION c <br /> 5. <br /> CL <br /> w <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION Y <br /> 0) 15�, <br /> STRUCTURE/ADDITION USE: t)j o o I i i ;} 1 I” 1,4 01CI ITT L 4A!f�,,44 0 <br /> (Home/Cabin;Commercial s; Bedroom; Deck;etc.) <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR /_�L q J13 O C <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m° 1 <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) ✓ ( r ) /�%M <br /> T Z <br /> 1. 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 e <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO M v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, <br /> STREAM OR RIVER. o <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. I <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 ` Oz. <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> 0 <br /> v � ; <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE qo„ <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> n I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITl <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 75 FEET OF THE OHWM OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> `2 w r O L <br /> 6. m <br /> vnwo5' 3 <br /> w <br /> 7. Z : V1 m� i or i <br /> o : <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ; C <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizeio m A <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- i p <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 application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above desc premises at any reasonable time for the purpose of Inspection. -n <br /> SIGN HERE f - <br /> ign of owner ui ng contractor) (date) <br /> ZONING ADMINISTRATOR H <br /> h 4*4044 H40 <br /> N NNNNN NN <br /> N 91 99"p o0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />