Laserfiche WebLink
1 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator vci Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> toll- 355-3721 L4-1k 6T a <br /> N <br /> ((�y(�� �t- C13�� 0� ja3 C5► -3-11-3056. 140� f a <br /> CD <br /> OWNER JAY a 1 �C55rn Ph�rnS Qga'l� n <br /> TELEPHONE -�Iy.t�G(o_ `1G�1`l Ckb. O <br /> v m <br /> C 1 <br /> HOME ADDRESS `6�3`I <br /> ID <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> i <br /> LEGAL DESCRIPTION(see tax receipt) �� /d C��a r 1_t(EL� a 3�(�o-/ J � 0 <br /> It Ir <br /> Tz b ) a <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE I ADDITION ❑ PRIVY ❑ m 0 <br /> TYPE OF PERMIT(S): c� <br /> FILLING/GRADING ❑ CAMPING UNIT 1:1SUBDIVISION ❑ 5 <br /> STRUCTURE/ADDITION USE: S rp c io I j I otOcy. 0 /t <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) 0) 1U <br /> BUILDING CONTRACTOR: � <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> y d <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p � <br /> CL <br /> 'TI Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). <br /> Cn 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO M 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <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 /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 64 <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. c <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHENq E <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o Q <br /> CONDITIONS OF PERMIT: llT <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Ci <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I <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. rnRr (.(jJcC1� Strl -i4s } LA.ItGC <br /> 6. /Vo cro-6-4. V� o` .e ycGyf 41u- - o '�- Slope L1Yi`E' 3 n a rn <br /> � O N N 9 _N C a O � 3 <br /> 7. Z : 1D7 <br /> ' <br /> er <br /> O <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 I am responsible for the detail and accuracy of "" i m � C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize C m m m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- p <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 premises at any reasonable time for the purpose of inspection. <br /> m <br /> C5 <br /> SIGN HERE <br /> ( anatu a of owner or lid contractor) (date) <br /> ZONING ADMINISTRATOR <br /> w w to to is fn <br /> N N 01 N N 0 N <br /> V1 <br /> V1 O N 01 O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0000000 <br />