Laserfiche WebLink
Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator oz <br /> APPLICATION FOR LAND USE PERMITS a <br /> 0 N <br /> 0 y \V\J1 <br /> OWNER /) TELEPHONE d <br /> MAILING ADDRESS I - rust--� 54- �J k) An -J o ver ny 54-53p <br /> f h <br /> PROPERTY ADDRESS <br /> F f7 C"lX C> <br /> J <br /> LEGAL DESCRIPTION 1-10 eke totem/D a y <br /> DWELLING/BUILDING GARA E/ACCESSORY STRUCTURE ❑ ADDITION ❑ STAI tS ❑ <br /> TYPE OF PERMIT(S): nr <br /> FILLING/GRADING ❑ CAMPING UNIT BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK ❑ � 4 <br /> STRUCTURE/ADDITION USE: ��ri l✓� GtIY� z ,�', <br /> (Home/Cabin; Commercial Busi ess; Bedroom; Deck; etc.) o <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Vz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING (ARIAL OR TOP VIEW) 0 2. e <br /> c <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. e�+f d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, rM <br /> AND INDICATE NORTH (N). °a R�O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILD NG(S) c <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MAR Ul ,E <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. _ o <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DIST NCES �J <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. C? c <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC. THE 5. <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE V HEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: — I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. ' Z C� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER j.,. a <br /> SETBACK AREA. W 0 <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE NLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7'7 DnmOD E ro <br /> 7. a lTl <br /> n y A <br /> N 9. 0. <br /> 9 PO C 0�0 <br /> [declare that this application (Including any accompanying schedule)has been examined by me and to the best of my knowl dge <br /> and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information p ^R y <br /> contained in this application (Including any accompanying schedule)and I further declare that I recognize that this informatl n I m 2 Y <br /> am providing will berelied upon by the County of Burnett Wlswnsln in determining whether to Issue a permit. I further acc t all N o w o <br /> liability that may be a result of the County of Burnett relying on this Information I am providing In this application. I agree t <br /> permit county officials charg with administrating county ordinances or other authorized person to have access to the abev - o QR A <br /> described premises a[any nable time for the purpose of inspection. cW �'c G] �, Z, > <br /> OWNER'S SIGNATOR -� ort o c n 2 <br /> (date) a a <br /> ZONING ADMINISTRATOR 1()`l <br /> 'm C <br /> c <br /> TOWNSHIP PERMITS MAY BE REQUIRED O <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE " <br />