Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator u A o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. 15 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- Mj( <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other v t J <br /> applicable Cou Ordinan and the laws and regulations of the State of Wisconsin. <br /> OWNER ,/1�` L �� ���� TELEPHONE ?��' ���r22 jl o <br /> HOME ADDRESS� b.li/I /nyl, {f <br /> 1 4 ✓_ Iw- '5i2igv �y97 <br /> EMERGENCY/FIRE NUMBER 111.....��� 1` 17i ROAD NAME NI4 <br /> R,11"i <br /> LEGAL DESCRIPTION (see tax receipt) 5(r'. JJ\\C, Z / f 3S Y/ /( ' -N /L„, 'Z dT <br /> NI►�RJ, AJt }�'' dd fx JL <br /> CONTRACTOR ✓ o <br /> TYPE OF PERMIT(S): DWELLINGBUILDING GARAGE/ACCESSORY STRUCTURE ADDITION c <br /> y r <br /> 0 <br /> 0 <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT-JSU�B�DIVISION ;� v <br /> STRUCTUR DDITION BE: L I th N O to 61 Ah NG. 40� �”" ill,l rar-120 '4 <br /> (Home/Cabin; Co mercial Business; Bedroom;Deck;etc.) <br /> r <br /> o_ <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 3 v <br /> T Z T <br /> 1. All required dimensions or distances to be shown or drawn to scale. m P <br /> 2. Show the location and size of all existing buildings(EB) and all new buildings(NB)and indicate in <br /> North (N). <br /> 3. Show dimensions in feet of the following: (a) building(s) to all lot lines, (b) building(s)to centerline of m s <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. <br /> 4. Show the location of the well (W), septic tank (ST)and drainfield (DF), and all distances to buildings, . <br /> roads, lake, lot lines. <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. T <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be <br /> signed and dated by the owner. <br /> ig <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE A PERMIT CAN BE ISSUED. <br /> o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 11� <br /> ISSUANCE. l� <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 <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> f <br /> 6. <br /> mR'� Pam ­ 7mt/ <br /> 7. = W �Z2mo = <br /> �0 <br /> ON <br /> 8. In[ c) m <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the bast of my m <br /> knowledge and belief it Is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of LC]� o o O <br /> all Information contained in this application(Including any accompanying schedule)and I further declare that I recognize r� . . <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 0: o <br /> providing in this application. I agree t it county officials charged with administering county ordinances or other : 3 c� <br /> authorized person v eeess to s vs described premises at any reasonable time for the purpo a of Inspection. m y <br /> SIGN HE <br /> (signature f owner or building contractor) (data) E o [ <br /> ZONING ADMINISTRATOR <br /> N N n N NN N in <br /> n <br /> TOWNSHIP PERMITS MAY BE REQUIRED o u o c u, o P ino <br /> Sgoogoog U) <br />