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 /> r <br /> N O <br /> y <br /> C <br /> /� T /� /� /� ,// <br /> OWNER /1I�/ 1 / l�D /` TELEPHONE <br /> oa LJ/ <br /> HOME ADDRESS S (f f <br /> r ° <br /> 0 <br /> EMERGENCY/FIRE NUMBER S� ROAD NAME <br /> 1 <br /> 4} <br /> LEGAL DESCRIPTION (see tax receipt) Q rn ellA6 <br /> DWELLING/BUILDING ❑ GARAGE/AC SSORY TRUCTURE ❑ ADDITION PRIVY , U) ° <br /> TYPE OF PERMIT(S): <br /> FILLIN DING ❑ CAMPING UNIT 1:1 SUDIVISION STRUCTURE/ADDITION US42/ <br /> n <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: <br /> C <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> A �. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m ; <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). Cl)C \ 3 <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. <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. C <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 2 <br /> MUST BE SIGNED AND DATED BY THE OWNER. Q <br /> O � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> Z <br /> V <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. // �C� (� <br /> CONDITIONS OF PERMIT: �J <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 65 AYS OF PERIV <br /> ISSUANCE. p <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTEDG SHOR6tIN . <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SLLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN T /Q/G)12EDWATER <br /> SETBACK AREA.5. <br /> 'l �(JV <br /> 6. m `� v °' � � - <br /> -O : M C ,yj, N O <br /> Z : �' CD <br /> N O <br /> 7. O : T m <br /> C7 : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 10 <br /> 0 A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize Q' m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> L) <br /> F <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 ° <br /> providing PP 9 P Y 9 9 county <br /> rovidin in this application. <br /> I agree to permit count officials charged with administerin coup ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. -n <br /> CD <br /> CD <br /> SIGN HERE <br /> (sig re ner or building. o rac (date) <br /> ZONING ADMINISTRATOR <br /> Zl G <br /> TOWNSHIP PE ITS MAY BE REQUIRED <br /> 23r� � <br />