Laserfiche WebLink
6*'77tlo <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 ,'f4APPLICATION FOR LAND USE PERMITS piny Administrator 3 0 0 <br /> r <br /> N � <br /> N <br /> OWNER x TELEPHONE <br /> C � \ <br /> HOME ADDRESS r/ f L � / LLrtv <br /> o <br /> EMERGENCY/FIRE NUMBER �(;tr}-y) D ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) <br /> T Ltr y-r I cL� �1 N <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ 1. <br /> TYPE OF PERMIT(S): <br /> FILLINL. _.^4DING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ rr <br /> STRUCTURE/ADDITION USE: 7 i('/.4/,/z /hxa$ LAS. <br /> 0 <br /> (Home/Cabin, Commercial Business; Bedroom; Deck; etc.) <br /> y <br /> BUILDING CONTRACTOR:�S�L <br /> -a <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) XI i;T <br /> " } <br /> c l <br /> O ii <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. In z <br /> v <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m xt <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 p <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. z <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 7 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 <br /> NEEDED. Cr <br /> 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: o /1 <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 w <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 /> _ <br /> SETBACK AREA.5. / I q <br /> 6. <br /> n r p O <br /> a oeF m <br /> m f = p <br /> 7, v eCw !^ oir s3 <br /> Z : Hyo : 9 =i <br /> o i :M'< M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my y m <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of C)d ' C <br /> all Information contained in this application(including any accompanying schedule)and 1 further declare that I recognize �' m a m <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 /> •viding in this application. 1 agree to permit county officials charged with administering county ordinances or other to <br /> '—d person to have access to the above described premises at any reasonable time for the purpose of inspection. rn <br /> n : <br /> (� na re of owner or b d g contractor) (date) <br /> tATOR <br /> NNH NNM�+ <br /> N NDN N VtN <br /> Vt N ON(1100 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0000000 <br />