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 /> 0 <br /> y O <br /> OWNER ,� W <br /> _ )& )A) TELEPHONE (—LIST— 6-?53 0 <br /> MAILING ADDRESS1 (. fet!A �A Q ✓ O� <br /> PROPERTY ADDRESS <br /> :See ro t <br /> LEGAL DESCRIPTION(see tax receipt) ) S CefD J Q I tiIM f3,J-� L a�S S �I AJLI �j 'riq >,v R M fJ <br /> Ei <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ I `' o <br /> TYPE OF PERMIT(S): ll v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ °- <br /> STRUCTURE/ADDITIONUSE: I Ala GZ ^ <br /> (Home/Cabin; Commercial Business;Bedroom;Deck;etc.) <br /> m <br /> BUILDING CONTRACTOR: <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'h X 11 SHEET OF PAPER. ANY INCOMPLETE OR (f <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n O 3 I <br /> /;a N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p m <br /> T n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T 0 Z-n A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m CD <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 3 <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. 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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> � o ( <br /> O 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN !"» o (fl <br /> NEEDED. N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: o SC <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. +U <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 G <br /> 5 SETBACK AREA. <br /> v CD W�J0 ID <br /> 6. 3 'am snm <br /> mcNyo � 3 <br /> 7. Z ^ N o : 'l 1 <br /> o n. z <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my — -' A <br /> L7 <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of C <br /> m n : .n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m E o m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m : C <br /> sue a permit. I further accept all liability which ma be a result of the County of Burnett relying on this information I am m <br /> providing in t is lication. I agree to permit ou ty officials charged with administering county ordinances or other o <br /> authorized pe on t have access to the above escr d premi as at any reasonable time for the purpose of inspection. m : = <br /> o : <br /> SIGN HERE w - 02-0 3 6A <br /> (� ' a <br /> (signature of ow building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> ' N)EA Irl) <br /> A d! N <br /> C 0`10 NN 0 00 <br /> Ln <br /> NOfT (TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />