Laserfiche WebLink
ot 5/TP- <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator a G z <br /> APPLICATION FOR LAND USE PERMITS 3 4 <br /> N 0 <br /> FL <br /> OWNER1 TELEPHONE � <br /> m <br /> 00 <br /> HOME ADDRESS ci -JIS� Z <br /> r <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) <br /> a <br /> Cl) 0 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/ CCESSORY STRUCTURE ADDITION- <br /> 9: <br /> w' <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 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 /> a <br /> DIRECTIONS FOR PLAT PLAN DRAWING: (AERIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH 3. SHOW DIMENSIONSIN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 3 <br /> 0 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. P <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. L41 <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 A PERMIT CAN BE 5 <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 0 <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 75 FEET OF THE OHWM OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> Ap DOS Og �OM <br /> 7d CML <br /> �E g <br /> 6. v'� � 0 5, IC <br /> 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 i n <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognizeo m i i m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- y O <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 /> P <br /> roviding In this-application. I agree to permit county officials charged with administering county ordinances or other <br /> authorize4 rs <br /> peon toha ccess to the above described premises at any reasonable time for the purpose of Inspection. n <br /> G��J e : <br /> N <br /> SIGN HERE <br /> (slonaiure of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR I i(n 4 I-di)Irk an <br /> N MfA 6fHHH <br /> N NNNNNfIi <br /> N ut O O N O O <br /> O0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED o O O 0 c 0 0 <br />