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 /> N <br /> N <br /> C <br /> N <br /> OWNER :� u;�Gu�l Q i C l `� �.>� TELEPHONE <br /> 2 <br /> MAILING ADDRESS I/ I �e/`a-e- 0.r►/ C� 5y3a� f <br /> CDCD <br /> PROPERTYADDRESS �o�1p� Cj I�,� Lo . a,r'l LuC <br /> CD <br /> LEGAL DESCRIPTION(see tax receipt) ( _ / 116 <br /> DWELLING/BUILDINGY GARAGE/ACCESSORY STRUCTURE ADDITION ❑ W ° <br /> TYPE OF PERMIT(S): cr <br /> C <br /> FILLING G DING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITIONUSE: O dY� O �C S� C(.f.(+'LLQ, <br /> (Home/Cabin; Commercial Business;Be m; Deck;etc.) cn <br /> m <br /> BUILDING CONTRACTOR: d <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE ORn 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m3 <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. 0 <br /> S. 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. C f <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z i <br /> CONDITIONS OF PERMIT: o <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. <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 /> vm mm d nym� a F� T <br /> 6. M a100COL. A3 <br /> 7. Z w o 1 <br /> o T� m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of myc C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m ° 40 <br /> - <br /> CL E� : 0 M <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m , 0 : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- C m <br /> sue a permit. I further accept all liability which may be airesult of the County of Burnett relying on this information 1 am d <br /> providing in this application. I agree to permit cou fficials charged with administering county ordinances or other o <br /> authorized person have acc ss o the abo d premises at any reasonable time for the purpose of inspection. m o <br /> - �� -0�- <br /> CD <br /> CD CD <br /> SIGN HERE <br /> a : <br /> (signature of ow or or buil i con ct r ate) <br /> ZONING ADMINISTRATOR QZ �J\ <br /> \EA d!(A fA 0 N <br /> N (TNN 00 <br /> CT O GT (T O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />