Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS 3° <br /> OWNER /(Q L ) J 1 1 1 CVC TELEPHONE <br /> HOME ADDRESS <br /> ' S 5/tet <br /> EMERGENCY/FIRE NUMBER/V_) / ROAD NAME `G/1/pj pI <br /> LEGAL DESCRIPTION(see tax receipt) Sh-� <br /> �� ( m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORYSTRUCTURE UtJ'ADDITION ❑ PRIVY ❑ V/ o <br /> TYPE OF PERMIT(S): v 0 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ ,a, <br /> � X3� <br /> y <br /> STRUCTURE/ADDITION USE: STO/P41o.� o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) Q <br /> m <br /> BUILDING CONTRACTOR: 19 <br /> F70f / � �S tom' iUS% <br /> 1 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 6'/s X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> O — <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) O m <br /> n n <br /> -n 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 <br /> NORTH(N). <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 �O Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 6� 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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS �v n` <br /> MUST BE SIGNED AND DATED BY THE OWNER. 5 c XJ <br /> � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN o 10 o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O <br /> ISSUANCE. (� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. XJ <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 AR <br /> 5. /1 e 0 � <br /> �7) � '/ t�c <br /> (�C� r.- <br /> 6. <br /> O OM <br /> CL M <br /> N C <br /> o <br /> ly : m <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of myc O <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m o : : C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize mm m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whetherto 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 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of <br /> inspection. <br /> CD <br /> CD <br /> SIGN HERE t /O� �/os / / `^ <br /> s gna a of o�wp r� buildin c2akillctor) (date) <br /> ZONING ADMINISTRATOR <br /> N N VI N S 8 <br /> (T U1 O(T O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />