Laserfiche WebLink
Burnett CBunty 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator _ o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> n O <br /> N <br /> C <br /> OWNER & � TELEPHONE <br /> V <br /> MAILING ADDRESS - F <br /> o <br /> PROPERTY ADDRESS 53 �� J <br /> LEGAL DESCRIPTION(see tax receipt) —� 1 l/��� �� v �l/s� <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ ` In <br /> � o <br /> TYPE OF PERMIT(S): n <br /> FILLING/GRADING ❑ CAMPING UNIT 1:1 SUBDIVISION L <br /> STRUCTURE/ADDMON USE: <br /> (Home/Cabin;Commercial Business;Bedroom- eck;etc.) <br /> BUILDING CONTRACTOR: <br /> 1 <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> XI N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) D a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m O 3u <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y 0 <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO c) <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 ) <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o SL <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: (ice <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. (Vv, <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 /> d <br /> 6. <br /> 3 nC Fad <br /> -o <br /> '0 C: 3 <br /> 7. Z mho : <br /> o T.� <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 7 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 recognize c�. m o G <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- -v' <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 d <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. m-CD <br /> o <br /> (o m_ <br /> yr w <br /> SIGN HERE <br /> a : <br /> (signature of ow(r or bul Ing contractor) (date) (� <br /> ZONING ADMINISTRATOR I <br /> fA(fl fA iA�N <br /> (� NCTNNOO <br /> `nom]] (TO (T (TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />