Laserfiche WebLink
Btirrett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator a o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 o \1 <br /> N G �V <br /> C <br /> OWNER I& A l J /20h&/M% hE/M% 1 TELEPHONE 71, <br /> SIJ mpp��\� <br /> HOME ADDRESS <br /> r � <br /> EMERGENCY/FIRE NUMBER OW/ ROAD NAME A 2®1r ; V <br /> jo1$"7- Y�?/i93 Z �S-��f-l�'o ol�pU C� a <br /> LEGAL DESCRIPTION(see tax receipt) .s t 3/T38lp15lW A C/?F L o T2 CSM V I P I F? M <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE I ADDITION PRI 4 <br /> TYPE OF PERMIT(S): VN Q <br /> n <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5. <br /> � � s <br /> STRUCTURE/ADDITION USE: a /41 <br /> (Home/Cabin; Commercial Bu iness; Bedroom; Deck; etc.) m <br /> C LEER y Batt , Nc CEly% a <br /> BUILDING CONTRACTOR: i <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/2 X I I SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 m <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) In CL <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE N c <br /> NORTH(N). 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m Oe v <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. c <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO u <br /> BUILDINGS,ROADS,LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 2. pp <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN g ° <br /> NEEDED. <br /> Z ©o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I <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 /> 5 <br /> SETBACK <br /> ,AREA. <br /> 40 O� joeabpc <br /> rn <br /> 1 rl VC.7'V 1 Vag m.� 3 am x-ar. <br /> 4' \ v , • 0 y N O i i i 3 <br /> 6. <br /> 4 <br /> I declare that this application (including any accompanying sch¢ s fined by me and to the best of my `o : ' C <br /> 0 <br /> knowledge and belief it is true,correct and complete. I acknpwt s the detail and accuracy of o E <br /> all information contained in this application(including any apanying sc a f declare that I recognize O m m <br /> that this Information I am providing will be relied upon by th unty Burnett Wisc s ermining whether to is- m p <br /> sue a permit. I further accept all liability which may be a resu of the�f,�urnett relyi on this information I am E m <br /> providing in this application. I agree to permit county officials charged wit a �jring c rity ordinances or other m <br /> authorized person to ve access to th bove described prem' reasonablLRM�e for q purpose of inspection. - <br /> m : <br /> 2C CpUN7Y Ge 3U� � C, <br /> SIGN HERE (date) <br /> (signature of owner orb uilding contractor) <br /> ZONING ADMINISTRATOR fn cn w to vi to <br /> N N (1 En(A <br /> 1 �a11 � � oLA inoo <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 0000000 <br />