Laserfiche WebLink
Burnett County 7410 Co. Rd. K,No. 102,Siren,WI 54872 Office of Zoning Administrator 'a o z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> S hCrrv�ar✓ � -� <br /> OWNER /.� !IE'!� TELEPHONE Oa CO <br /> W <br /> HOME ADDRESS LAS 1 V ' <br /> ( g <br /> EMERGENCY/FIRE NUMBER '� 0 ROAD NAME Oo,k 41C PJ I f <br /> l <br /> S <br /> LEGAL DESCRIPTION(see tax receipt) S (,�yy S F yyy,T3 qv `1 �J N <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION Cr C <br /> n <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> y <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Comm r al Business; Bedroom; Deck;etc.) 'a 7 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 T <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m ^� <br /> N <br /> to <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> 3 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m �b <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). ` o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. o <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. `L <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IV <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. m sos <br /> O 9 w <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> 4 0 <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <br /> I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. C <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 /> .'0 m O O M <br /> 6. Dae t% <br /> 7. o w � <br /> _y <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my n{ g p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofCL <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I 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- m E E t7 <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 n <br /> authorized person tq have access tip the above described mases at any reasonable time for the purpose of Inspection. -, <br /> SIGN HERE / ' <br /> gna re o own or Ilding contractor) (date) �J <br /> ZONING ADMINISTRATOR �� <br /> Id1HH fI1MH <br /> N N VI N fJ1 V1 <br /> V• Vt O V7 O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 0 0 0 0 0 <br />