Laserfiche WebLink
"16e" <br /> 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 <br /> y � w <br /> c �(� <br /> a \p <br /> OWNER TELEPHONE m ` <br /> HOME ADDRESS bQl go( -,0 �� <br /> AA r CD <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME I n <br /> ( p) C�Sh-, y , CD <br /> 95 CA <br /> LEGAL DESCRIPTION see tax receipt) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ 0 <br /> y <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT El SUBDIVISIONS <br /> L n <br /> STRUCTURE/ADDITION USE: / ! 1 /� a3a-a33 0 <br /> (Home/Cabin; Commercial Business; Bedroom Deck; etc.) rn <br /> BUILDING CONTRACTOR: �J iu <br /> 1 <br /> v • <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR m <br /> T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O F _r <br /> 70 � l,T <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O (D <br /> n o. <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n 00) � � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). N 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <br /> v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF I • <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Q, <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. c o <br /> 0 9 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN 0 0 I <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z V <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ( f <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 � mc� )^o5' 3 <br /> 7. o . <br /> = cl' 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 m � <br /> c <br /> ,0 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I 0. <br /> 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- d O <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 d <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other Co <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. ,) <br /> CD : <br /> CD : <br /> SIGN HERE <br /> (signat e f owner or buildin n actor) (date) <br /> ZONING ADMINISTRATOR Fn <br /> Fn Fn fn w to cn-� <br /> N N ut N N Vt N <br /> N NP <br /> UIWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />