Laserfiche WebLink
&4V-OW <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator CD o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 < R <br /> N .it <br /> C V <br /> CD <br /> OWNER !f II! 1, G(hi TELEPHONE 43S 7,DS9 <br /> /l <br /> /v <br /> CD <br /> HOME ADDRESS C n-L- Qd U-,}, J-21VQ r O <br /> ID <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) l_ <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTUE ❑ ADDITION ❑ PRIVY ❑ c o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISIONS.y <br /> STRUCTURE/ADDITION USE: � n►� <br /> ( ome/Cabin; Commercial Business; Bedroom; Deck; tc.) m <br /> BUILDING CONTRACTOR: <br /> _ IV11170�7 AOL! v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> MH c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 ii <br /> 'n O Z <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 m n <br /> NORTH(N). in ° <br /> 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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS o <br /> MUST BE SIGNED AND DATED BY THE OWNER. o 0 pbV <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a ° <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. pz <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ZL <br /> ISSUANCE. QJ <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. I L\ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. v <br /> 5. A 71 0'r- Q o v <br /> 6. N9o.Ny9 <br /> o ' 3 <br /> mCut . <br /> O O <br /> 7. c w CMD � 1 <br /> Cn : i M <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Cr c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize '^ m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <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 <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. m <br /> Q : <br /> m : <br /> SIGN HERE <br /> (signature o ner or building contra c r) (date) <br /> ZONING ADMINISTRATOR En Fn w(»fn v+ <br /> N NCA N N OOI <br /> O 0 0 0 0 0 0 <br /> TO NSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />