Laserfiche WebLink
(� C&-xy� <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0 z <br /> APPLICATION FOR LAND USE PERMITS 3° <br /> r <br /> OWNER �I ✓)1awe5 TELEPHONE 7) <br /> HOME ADDRESS <br /> a 0 Los ko6les ,Di_- &lm S n'A C'� o <br /> EMERGENCY/FIRE NUMBER flog ROAD NAME FLak <br /> LEGAL DESCRIPTION (see tax receipt) 1 y — <br /> OD N o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION C <br /> Cr <br /> a <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT /SUUBDIVISION 0 <br /> STRUCTURE/ADDITION USE: C 5/ i t V l r l ��~ ` v <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> In <br /> 3. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> z N ODIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) O n <br /> ,n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS (NB)AND INDICATE m !" <br /> NORTH(N). CO) o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m U� 3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, z <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. S 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. 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. --I U10 <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> 0 <br /> CONDITIONS OF PERMIT: (1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT -C <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. O <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 /> 6. m 6< 3 a M X 2. ;U <br /> N C w N G 3 <br /> 7. M <br /> = O � <br /> O G <br /> = W m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Lj i p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> CL <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD n, M <br /> M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m : <br /> m : <br /> to <br /> SIGN HERE <br /> (signatur/e�of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> cA <br /> ri m f»Fn cry cn <br /> N N (nNNfTN <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />