Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 ° <br /> r <br /> N � <br /> N <br /> OWNER yIC oce-i ! TELEPHONE2,7422,1 <br /> n <br /> G 11 ID <br /> HOME ADDRESS aj. G ��� 'R J , f tt/pr! �� 1 t��� v 0 <br /> r m <br /> EMERGENCY/FIRE NUMBER a(\42-6 ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) fir y <br /> . c <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE I�1 ADDITION PRIVY y o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CA APING UNIT ❑ SUBDIVISION ❑ 4 <br /> II'''' / N• <br /> STRUCTURE/ADDITION USE: 'C<t�'�P I (.,,ccl`gtr6, ��X� o' <br /> (H me/Cablh; Commercial Business; Bedroom;Deck;etc.) m <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ,7 T <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING XI(AERIAL OR TOP VIEW) p <br /> n G <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 :? <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. z <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. 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. to <br /> 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN o 9a o (fl <br /> NEEDED. c. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c . <br /> CONDITIONS OF PERMIT: ' <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 /> 6. Aid; M�gm <br /> 3 a % <br /> 7. o to =i <br /> o m <br /> = y€ m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <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 CLi m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- p <br /> sue a permit. 1 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 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> - <br /> SIGN HERE i�'/ <br /> � signatu owner or building contractor) (date) <br /> ZONING ADMINISTRATOR �Jmn f:1-aril, <br /> r� , <br /> to to w to to to <br /> N N r1� N N f!I N <br /> IT t)1 O VI(r O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />