Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Admin r m c 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> y O <br /> H I <br /> �"/ O OC4 <br /> OWNER LO I S{� ' TELEPHONE <br /> {� <br /> HOME ADDRESS 3 3 ( � y � 6 � L4)13SLI- pa1c° <br /> Q 0 <br /> EMERGENCY/FIRE NUMBER NONE ROAD NAME ��x r(/ <br /> "� <br /> LEGAL DESCRIPTION (see tax receipt) S yq (JYy 5e / 'rLI�NCD <br /> I �y � <br /> DWELLING/BUILDING 1:1 GARAGE/ACCESSORYSTRUCTURE ❑ ADDITION El PRIVY L251 rn 0 <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT 1:1SUBDIVISION ❑ n <br /> m' <br /> STRUCTURE/ADDITION USE: Fir f V \ o <br /> (Hom abin; Commercial Business; Bedroom; Deck;etc.) y <br /> BUILDING CONTRACTOR: Se/P <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p _ <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> ,n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C1 m a <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m - <br /> NORTH(N). W o <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. p <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. 15 <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. o o I <br /> v � o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN 4 <br /> NEEDED. a <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. 0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. > I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ( C <br /> AI <br /> CD W M <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER t <br /> SETBACK AREA. <br /> 10 5. <br /> I <br /> N N O W F m <br /> 6. O fD C Nil W O CP 0, ELfOd 3 <br /> Z m N 7 1 <br /> 7. 0 : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Q7€ L7 c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of n <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizem ;U <br /> M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- l7 <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 (R m <br /> authorized person to have access to th tribe emises at y reasonable time for the pur ose of in ection. <br /> m : <br /> r q 1D <br /> 64 <br /> SIGN HERE / <br /> ( gnat a of owner or building contractor) (d e) <br /> a <br /> ZONING ADMINISTRATOR o to <br /> r' v+to to in <br /> On N N to <br /> o <br /> O OOn O O <br /> 000o0WNSHIP PERMITS MAY BE REQUIRED <br />