Laserfiche WebLink
Burnett Gounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - c o <br /> APPLICATION FOR LAND USE PERMITS 3 r- <br /> r <br /> s'tGU� SaLSo.v �✓.�Gl �OJGt�s" �o� <br /> OWNER C UYt `dVLhSoVL TELEPHONE <br /> HOME ADDRESS v1$ ` DWr L J!9 �(i1+[ �C[N 6�+�ti y / w• �7g� r rp <br /> EMERGENCY/FIRE NUMBER a �ocV ROAD NAME o <br /> fv S <br /> LEGAL DESCRIPTION(see tax rec pt) �� S CSrn V I/ r��Q a`(J— `b 0 <br /> ' d c <br /> (� o <br /> DWELLING/BUILDING ElGARAGE/ACCESSORY STRUCTURE N ADDITION ❑ PRIVY ❑ c <br /> TYPE OF PERMIT(S): 17 <br /> CL <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ F I�x Q.rj S. <br /> N <br /> STRUCTURE/ADDITION USE: h'lo� l +x Q ��ra 4 a z. C (rtot� <br /> (Home/Cabin;Commercial Busl s; Bedroom;Deck;etc.) d <br /> ii E <br /> BUILDING CONTRACTOR: `O M S YLO L.3 C✓'S Er R I7 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 y (n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Om c. C Sl <br /> Z <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 rn o <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF \ c <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q °. <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: �J <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. r� f <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY W <br /> 4. NO STIRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER C <br /> SETBACK AREA. <br /> 5. M -00r' � ov <br /> 3 M <br /> 6. <br /> Z : <br /> m i <br /> 7. o m <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of E , <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize C^ rr <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 ; m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described preipops at any reasonable time for the purpose of inspection. <br /> m : <br /> SIGN HERE (date)�r— <br /> (slgnat of owner or build ntractor) <br /> ZONING ADMINISTRATOR �YL <br /> �wts <br /> OTOWNSHIP PERMITS MAY BE REQUIRED o 00 0 <br />