Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v0 z <br /> APPLICATION FOR LAND USE PERMITS <br /> r <br /> N O <br /> n / N <br /> OVMIER TELEPHONE <br /> MAILING ADDRESS/Qr/ ?96f 7 01 ad�as s,Ly�33 <br /> :D <br /> o <br /> PROPERTY ADDRESS jq � �x <br /> LEGAL DESCRIPTION(see tax receipt) L hs- 61ack j A7 �` V <br /> DWELLING/BUILDING ❑ GARAG CCESSORY STRUCTURE P/(ADDITION Ela y 1 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING��yC�AMMPING UNIT ❑ SUBDIVISION <br /> ,❑ n <br /> STRUCTURE/ADDITIONUSE: V GL/ `f D o <br /> (Hom abin; Commercial Business;Bedroom; Deck;etc.) CA <br /> m <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p � <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m �? <br /> NORTH(N). C <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. o <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. <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. 1 <br /> q � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: Q!N <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I <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.5. CA,� <br /> �r)V—XtC_ <br /> ��/�u ` A (� r D4 D O S <br /> 6. M 3 n9 FCL m <br /> 7. Z fal ry O O f0 <br /> G i jjQ : : : x <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my (j g i A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o a N <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m !4 : O : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- : m : <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am E m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or otherco <br /> w <br /> � : • <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. '^ <br /> M O : <br /> SIGN HERE m m <br /> CL : <br /> (signaturSee of ow <br /> N un ner or building contractor) (date) <br /> ZONING ADMINISTRATOR I <br /> (A fA0 N <br /> r� N r)N N O O <br /> 010NN00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED � <br />