Laserfiche WebLink
Burnett County 7410 Co.Rd. K,No.102,Siren,WI 54872 Office of Zoning Administrator - o° a <br /> APPLICATION FOR LAND USE PERMITS <br /> WY3 <br /> OWN `— <br /> ,n <br /> l n�� SSID Q <br /> MAILING ADDRESS � ��1t�1•rr �✓,`S � S�dA(1 r m <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) Sze <br /> ` <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION N <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADIN �I CAMPING UNIT El SUBDIVISION ❑ a <br /> C/. jV- <br /> STRUCTURE/ADDITION USE: k i+ /�Y�� o <br /> ome/Cabin;; ;Commercial Business; Bedroom; Deck;etc.) I 1 <br /> BUILDING CONTRACTOR: <br /> .9 <br /> (D <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR _n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> N 7Z) 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m D <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y_ o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m a <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 /> I <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. c <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. n <br /> g ' W <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN $ <br /> NEEDED. a U Y <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> I <br /> 73 71Z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 90 2 l <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 �O <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. y <br /> wmcDi8af m <br /> 6. 3 G N N - <br /> D W N• 7,0 <br /> 7 Z a . 0 <br /> . : <br /> ° : -n . : m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m <br /> PP (� 9 Y ) Y Y <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m Fn <br /> 10 CL u <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize : m m O i me <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ; <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett rj�%e <br /> on this information I am m S <br /> providin in this application. I agree to permit county offi unty ordinances or other o <br /> m : rn <br /> authoriz person to ve ac ss to the above described _ a o e purpose of inspection. c <br /> �C -- — CD <br /> m E m <br /> SIGN HERE �' E <br /> (signature of owner or b ng tractoi)jUL 6 2004 ! (date) n i <br /> ZONING AD NISTRATOR I0 <br /> IZI�r� NETT COUNT,, 1 C OI� IV N(�l1 (aO O <br /> TOWNSHIP PERMITS MAY B9fik �UIRED u O N <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />