Laserfiche WebLink
v rL� <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N O^ <br /> N <br /> co <br /> C <br /> onaa 'K �err-e�s 6 ` I- `T 73'x&^ <br /> OWNER TELEPHONE " o � R <br /> HOME ADDRESS .. � \ <br /> l D 4541I �- mi ssQB� I <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> I <br /> LEGAL DESCRIPTION(see tax receipt) )V 6'(1 O �s � 6V co <br /> CZm <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE A ADDITION ❑ PRIVY ❑ I m <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADI ❑ CAMPING U IT SUBDIVISION ❑ q <br /> -- � 7 N. <br /> STRUCTURE/ADDITION USE: 0 <br /> ( e Cabin; CommWcial Business; Bedroom; Deck; etc.) m <br /> BUILDING CONTRACTOR: Er <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O c <br /> Mn <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m a Q A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <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 B <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Q� �' <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 ' o <br /> SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO �-�}. <br /> BUILDINGS, ROADS,LAKE, LOT LINES. V <br /> S. 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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> O 9 C1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT f <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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 /> SETBACK A EA. <br /> 5. S'7ru-cffs�e �vr S ' v je- o 1, / /ut �r Clur►1Q h46� y r <br /> / X -0 0r-� 0 O -V <br /> m C m c <br /> 7. Z • m CWD <br /> o : <br /> -m: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G)c 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 I further declare that I recognizeV j m ;13 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- : O <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 E <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person ave access to the above descr' ed premises at any reasonable time for the purpose of inspection. T <br /> (o : <br /> 40 <br /> SIGN HERE <br /> Igna ure of o e r Ing contractor) (date) <br /> ZONING ADMINISTRATOR v+ <br /> N N NNN (T <br /> ()1 N O Un O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 <br />