Laserfiche WebLink
Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a 3 <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER rcVA�IT TELEPHONE �� _ �-1 I_ mi �C�) n S� <br /> MAILING ADDRESS (. / 111�',zPJ� r jq JQ 1 n PT A ! d o U ' <br /> PROPERTY ADDRESS M U, <br /> IL ,J�f <br /> LEGAL DESCRIPTION Cr 5M Uz I(0 I` p_ 3qV 16 o• <br /> TYPE OF PERMrI(51; SINGLE-FAMILY DWELLING 0 ADDITIONX_ DECK 0 GARAGE/ACCESSORY STRUCtUME ❑ ( n <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS 0 FILLING/GRADING 0 CAMPING UNIT C¢ <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE o <br /> J �/ <br /> STRUCTURE/ADDITION USE: 4,11! �.t //(.✓Q p M 4 6A; it y c D YI'� 0./N/'�� 10 k <br /> (mom /Ca m, commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: O Ir e ly' <br /> A PLOT-PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT LANS C o <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <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/STRUCTURES (EB)AND ALL NEW o <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 3 <br /> AND INDICATE NORTH (N). p <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDIING(S) o o <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK o O <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 DISTANCES �O <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. W <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE 'j W <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. /0���� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE W�iEN 4� <br /> NEEDED. ^ y <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT, ,$ Y <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. d Z 4 O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �' Q <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. , <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> 6. ]NOT TO BE USED FOR HUMAN HABITATION, q <br /> 7. 7tF <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of myI y c � Q <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all 5 ' R R <br /> Information contained In this application(including any accompanying schedule)and I further declare that I recognize that this' °D D m ti <br /> Information 1 am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issueo a permit. I d a 9 a n= Y <br /> further accept all liability that may be a result of the County of Burnett retying on this Information I am providing h this Q „ «w S ;,,N IV <br /> arson to have y <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized p — Q° ^+ o o C' <br /> access to the above-described premises at any reasonable time for the purpose of inspection. c w o g : o o 1" <br /> nao�Nooy <br /> OWNER'S SIGNATURE <br /> (date) n i' d = ',-e; <br /> c$ F3 <br /> ZONING ADMINISTRATOR <br /> WNSHIP PERMITS BE REQUIRED ; Q <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> J U O y VO <br /> 1A O O p O p <br />