Laserfiche WebLink
Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o o <br /> APPLICATION FOR LAND USE PERMITS 3 j <br /> N O» <br /> iIC)A m � \^ <br /> OWNER rk �Jl TELEPHONE ?jS- 56 "3 66 0 0 ���D! <br /> MAILING ADDRESS 5 �� et <br /> 3D <br /> � o l <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) $T<fYan o-6 /wp• `�/ /Q. �G /w�Z NIv y5/ cir SW SE LyG N <br /> 44 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION LOAN Cn p <br /> TYPE OF PERMIT(S): `v r11 . <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SS�UBDIVISION ❑ �g� a <br /> 44 <br /> STRUCTUREIADDITION USE: ca U r — i0 IX(� <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;et rn <br /> m <br /> BUILDING CONTRACTOR: C iu <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O `m -� <br /> n C <br /> T v Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO M <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <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. Nw <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONT OR, ETC.,THE PLANS 0 &J <br /> MUST BE SIGNED AND DATED BY THE OWNER. 9 0 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICAT16A"k+L� <br /> NEEDED. c 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. APR , / o <br /> 4 <br /> CONDITIONS OF PERMIT: BURNS <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT CQ <br /> ISSUANCE. ZQNI �NTy <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. NG <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 V\ <br /> SETBACK AREA. <br /> 5. <br /> 0r0 <br /> DO � <br /> 6. $m i n n n C m <br /> m n - A <br /> O m C y N O 3 <br /> 7. Z N C O 10 <br /> O T Gco: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of myC <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of m n En <br /> C .. ; 0 <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize C� m o n1v <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- j jm <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am m <br /> providing in this application. 1 agree to permit cou officials charged with administering county ordinances or other <br /> P 9 pP 9 Pe rJ1Y 9 9 ty <br /> authorized person to have access to the above descri a ises at any reasonable time for the purpose of inspection. CD o <br /> SIGN HERE / Gr , 7 03 n <br /> (signsre o owner b ding contractor) (date) C <br /> ZONING ADMINISTRATOR C`1 <br /> V0fA fA f9 fA � N <br /> N V t N N O O <br /> (T O Ut U• O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />