Laserfiche WebLink
Burnett County 7410 Co. Rd.K,No.102, Siren,WI 54872 Office of Zoning Administratoro° c <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER <br /> �✓� • TELEPHONE <br /> � . O <br /> la()1 eroo O <br /> HOME ADDRESS lay ��� ✓k �L� 8�� r <br /> C3 <br /> EMERGENCY/FIRE NUMBER ROAD NAME M i+-cbof C--)- �kj�- <br /> LEGAL DESCRIPTION(see tax receipt) 6.5 '013-4 29 V B e. �-5 L 5- *L40 I Qj_ <br /> 47 0 <br /> o (� <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE------ADDITION- <br /> CL <br /> 5. <br /> 4— <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> uJ <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p oi <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T 06 <br /> RI a • Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m g QJ '.o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE N o <br /> NORTH(N). <br /> 3 CENTERLINE OF ROAD,OC)BUILDING(S)MEASUREMENT TOT ENS IN FEET OF THE FOLLOWING: (A) (ORDINARY HIGH WATER MARKIm <br /> SHOW (OHWM OF LAKE, p <br /> Z <br /> 0 <br /> STREAM OR RIVER. <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. �L <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. o L <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a B Q <br /> ISSUED. <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT61 <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. 3 a a A <br /> rro o 9 r. <br /> o <br /> 6. <br /> � w �m i <br /> �Q i <br /> 7. =Cn' i m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my -"(�v Zf C <br /> knowledge and belief It Is true,correct and complete. 1 acknowledge that 1 am responsible for the detail and accuracy of A a : , <br /> all information contained in this application(Including any accompanying schedule)and 1 further declare that I recognize , , G <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 1 am o <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 described premises at any reasonable time for the purpose of Inspection. , <br /> m : <br /> H : <br /> SIGN HERE (date) <br /> (signature of owner or building contractor) <br /> ZONING ADMINISTRATOR �rn <br /> N NN NNQI ut <br /> ut NONfn 00 <br /> O 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />