Laserfiche WebLink
6-�2&7>-Vgb <br /> BL ..y 1410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -CID o c <br /> APPLICATION FOR LAND USE PERMITS 3 4 <br /> r <br /> N <br /> OWNER TELEPHONE��/ lsS (O�ly� n <br /> Qn �-1 p <br /> HOME ADDRESS !!S 2 S' 414 1� So — � �t r, I Cts Y {J U I <br /> EMERGENCY/FIRE NUMBER j 9 y ROAD NAME i <br /> LEGAL DESCRIPTION(see tax receipt) 5 alb T yb /21d /T6 Q <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE 1K ADDITION ❑ PRIVY ❑ b) <br /> TYPE OF PERMIT(S): a ' d ' <br /> FILLQNG,/GR®DING ❑_CAMPING UNIT ❑ SUBDIVISION El C S. <br /> STRUCTURE/ADDITION USES P_'��� °�r r� — 'i O F 3431 Tr�.�� A �ovr,S�pY 45� _ 0 <br /> (Home/Cabin; Commercial Business; Bed odm�, 13x6, r� <br /> BUILDING CONTRACTOR:• o <br /> td <br /> N <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81A X 11 SHEET OF PAPER. ANY INCO LETE <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. u In id -111 <br /> (AERIAL OR TOP VIEW) C)In <br /> (� <br /> 1. AEiflR9d*TA*QGS.TIEi,L #W0,,W OR DRAWN TO SCALE. n m <br /> �'>a flFaM`doBftTJMQr'WJOM� 'lYN{1A1:t-*SAN'S }AWWMATE C <br /> MOR !{M►� rn c <br /> 3. {ABUMrD111W +TitALL LWT. O m <br /> PF \o <br /> ROAD,foi fOb"0 0RCWA` Y tN�t' OF Z <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. ;8010At k*PFT��IHAkc :'i�PAGTIIMK�TI.A�-�R4.L�Fa�W{DF�,AND ALL DISTANG TO <br /> ;V ki ,' )1 <br /> LAM LWEs.� � <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. oN <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. m o <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Cr <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z I <br /> CONDITIONS OF PERMIT: c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. (� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY XJ <br /> PERMITTED. QN <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> z 'Uc1r oov <br /> m <br /> 6. , c c . 3 <br /> 7. c : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my w C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of a <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that 1 recognize - <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- t 0 <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 V <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m <br /> SIGN HERE �D 1 <br /> (signatu of owner or bull ng c a r) (date) <br /> ZONING ADMINISTRATOR <br /> 4ft 4ft,. A40 <br /> K)(A N En CA <br /> (]1 O `1 N O o <br /> OWNSHIP PERMITS MAY BE REQUIRED o o o 0 0 <br /> 000 000 <br />