Laserfiche WebLink
J <br /> Btenett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> y O <br /> OWNER TELEPHONE /s- 6.3 3-341-5— <br /> Fr n Ga <br /> amc — /'� agnuSof1CD <br /> `fv <br /> d <br /> ^ ^ <br /> HOME ADDRESS f)txlCD <br /> I ' r 0 <br /> EMERGENCY/FIRE NUMBER as ga l ROAD NAME C a�„}y RA. • o <br /> W ) <br /> LEGAL DESCRIPTION (see tax receipt) �D f of &u. G of I SPG • a2.s' 3$' �� Q Cn �1 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ <br /> TYPE OF PERMIT(S): Q ' <br /> FILLING/GRADING E CAMPING UNIT ❑ SUBDIVISION ❑ n 4 <br /> STRUCTURE/ADDITION USE: I Idrv1'L 0 <br /> nn (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: hpoed aCkILt kDmes vl1 <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O m <br /> -n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Cki o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO `�y <br /> BUILDINGS, ROADS,LAKE,LOT LINES. v 1 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. ( <br /> 1 N (� <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS W <br /> MUST BE SIGNED AND DATED BY THE OWNER. t o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT t Q <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. "AV J <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. v <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. A &ckJIB / 7n ,, n5. �e l� // 4 '`tee �(�'l /�/e-vl � -00r- > 0 > f m <br /> (D . N d 0 CD CL <br /> 6. 0 < B a m x n D <br /> N0 <br /> y 0 = iC <br /> (/, N O 1O <br /> 7. O : TI <br /> = c : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 3 = C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize PP ( 9 Y ) 9 mom ; p <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 ° <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or otherCD <br /> authorized person to have access to the above des ed premises at any reasonable time for the purpose of inspection. m <br /> ID : <br /> CD <br /> ^� <br /> SIGN HERE R J/ IjA <br /> 3 <br /> (signature of owner or building c frac ) ( te) <br /> ZONING ADMINISTRATOR <br /> b <br /> TOWNSHIP PER TS MAY BE REQUIRED <br />