Laserfiche WebLink
C A Y y1p <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N 0 <br /> H <br /> C <br /> yWWy��� d <br /> OWNER /// ' 1444J( TELEPHONE <br /> 144 <br /> HOME ADDRESS �0 17 40 &y0f If n �C,` <br /> (A!„l�,a•, Sirs) � <br /> CD <br /> EMERGENCY/FIRE NUMBER �yG ROAD NAME B�Y4 01 41n 1 <br /> LEGAL DESCRIPTION(see tax receipt)/ 3 7 40 N J/C w 1'Je�► Vel 6 5 dJ Uy I y <br /> m <br /> e <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ r 0 <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ °' <br /> S. <br /> N <br /> STRUCTURE/ADDITION USE: �e'L .0-44 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) y <br /> BUILDING CONTRACTOR: 901we, nJ�l4fa/�. b <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> XI H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OIn o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ;? <br /> NORTH(N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO rn3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OH WM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <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 /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N Q 1 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 0 `rte <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> v � d <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN ° 1 <br /> 4 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ZQ <br /> CONDITIONS OF PERMIT: P Tr 1,j <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I <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 AREA. <br /> 5. <br /> 6. B1 9CLG <br /> • el C N <br /> 0 0 <br /> 7. Z ' N nom : IO <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 c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of a C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize . M <br /> fD : : m <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 d <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 tqtIVp0V91WcrIbed premises at any reasonable time for the purpose of inspection. <br /> 6k*SIGN HERE � <br /> (s re or or <br /> building con or) (date) <br /> ZONING ADMINISTRATOR <br /> N Nn1NN(T (rl <br /> Vf V1 O ut Vt O O <br /> NSHIP PERMITS MAY BE REQUIRED c <br />