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 0 —V <br /> Vl <br /> C <br /> OWNER Ke(" /` r TELEPHONE <br /> HOME ADDRESS83 5 S 17 3 re` ��, i ��j�G U.11t . 14t ICS c igJ l/G4 r 9 <br /> 0 <br /> EMERGENCY/FIRE NUMBER jOtoH f6� ROAD NAME B pl,t n T y �G <br /> l <br /> Q. <br /> LEGAL DESCRIPTION (see tax receipt) COD) f <br /> C4 <br /> 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE-ADDITION- <br /> SANITARY- <br /> TRUCTURE ADDITION SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISIO 01_ <br /> STRUCTURE/ADDITION USE. <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc. 1 <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR �' 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> /� /��j/ <br /> / 'A//,�) LF' A N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) V O o <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :? <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 1 \v <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 0 <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- 3(� <br /> INGS, ROADS, LAKE, LOT LINES. 1 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. SIV <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS i <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 (� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 0 <br /> ISSUED. �- <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o I 1 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <br /> ISSUANCE. I Q <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. <br /> cmcD . ww 0 v <br /> 6. � < � amxc = <br /> Ia C N y O j <br /> Z N 0 O = 1 <br /> 7. <br /> -N : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my L) 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 an accompanyingschedule and I further declare that I recognize m m <br /> PP ( 9 Y ) 9 m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- y t7 <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 m <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. -n <br /> m : <br /> m <br /> SIGN HERE <br /> (sig ture of owner or b I ng contractor) (date) <br /> ZONING ADMINISTRATOR <br /> • F» F»wwwvi� <br /> N NOl NNOf <br /> (r Oi O un . P" O <br /> 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 <br /> 000000 <br />