Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> F O <br /> 41 <br /> CD <br /> OWNER Ul9UI� 9rt TELEPHONF� -7vC /�/6 v �_ <br /> d <br /> HOMEADDRESS <br /> 85 ztil�y G� �'dJu W7* A/ -5:5 F <br /> r m <br /> EMERGENCY/FIRE NUMBERAV J�� ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) d C4' { 4 if z r91/rG�J J W o <br /> I tpY� <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDIN GARAGE/ACCESSORY RUCTURE;4 ADDITION CK PRIVY ❑ �J y 1 0 <br /> FILLING/GRADING ❑ CAMPING/UJIT ❑ SUBDIVISION ❑ <br /> STRUCTURE/ADDITION USE: /4► i✓V o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) rn ' <br /> BUILDING CONTRACTOR: C,2/hL�Jv� �L /yL 0 <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR a^ <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n <br /> 2a c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. o Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <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 c <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. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 9 D <br /> BUILDINGS,ROADS,LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N v' <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: ° I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT U{ <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. � //C <br /> 6. � �j,�,,� / ID oni m 0 CD as E m <br /> 7. 5 I SYSf ✓er, . d 'Pe """1 / /J 1 S a�C'�d �.� 3 C x <br /> VV //( //!! /// / N ' <br /> SJS IcyQ/LQ I� O y 7 : r� <br /> '-' m <br /> I declare that this application (including any accompanying schedule) has been ex mined by me and to the best of my ti A <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 1 recognizeCL <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Is- C <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 L7 <br /> m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection, fD <br /> CD <br /> g m : <br /> SIGN HERE �7 <br /> (signature of owner r bull Ing contractor) T— (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />