Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872Office of Zoning Administrator Oq V Z <br /> APPLICATION FOR LAND USE PERMITS 3 < ° <br /> OWNER <br /> TELEPHONE?�J <br /> -d y -,:? o <br /> HOME ADDRESS <br /> �cf-r s 00 0 i 1 0 <br /> r m <br /> EMERGENCY/FIRE NUMBER a a?D 6:, ROAD NAME qh o/ —7` <br /> / <br /> LEGAL DESCRIPTION(see tax receipt) 4—Q /-y- a6 Q kXS 0OIt <br /> i� <br /> / g <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITIONy Co 3 <br /> n <br /> 5. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> =' <br /> �al I <br /> STRUCTURE/ADDITION USE: ea.50� D rC{ (0^S <br /> Hom abin;Commercial Business;Bedroom;Deck;etc.) <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. . <br /> m m7 f f Adc- At O <br /> DIRECTIONS FOR PLOT PL6N DRAWING- (AERIAL OR TOP VIEW) G <br /> 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. — v —�Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ar <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 10 9 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, <br /> STREAM OR RIVER. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- <br /> INGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE APERMIT CAN BE 0 <br /> ISSUED. Cr <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z G <br /> CONDITIONS OF PERMIT: o <br /> 1 <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 75 FEET OF THE OHWM OF LAKES, <br /> PONDS R5. )4601I ER UNLESS SPECIFICALLY PERMITTED. L <br /> 6. 3 0 it TO <br /> a <br /> 7. N o m ; <br /> Z : w Z 1 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my m <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m ` C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize �m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- E L7; p <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 in this application. I agree to permit county officials charged with administering county ordinances or other i <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. , <br /> - <br /> SIGN HEREyi <br /> M �� H <br /> (jsZure of owner or ullding ntrector) (date) <br /> ZONING ADMINISTRATOR <br /> Ffl FA!A ri FII -+ <br /> N N fn N <br /> U1 NON , <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 o 0 0 <br />