Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator -0 G) C Z <br /> APPLICATION FOR LAND USE PERMITS 3, <br /> r <br /> m o <br /> OWNER / HJ i— H S DLSU N TELEPHONE 7i5 S/ ! J t_L - 0� Et <br /> O <br /> v.+ 'tea Q <br /> pp 2 9 <br /> MAILINGADDRESS 790 L6/VE PINt R4 WC Sir W O <br /> PROPERTYADDRESS 5,4 L �,Up o E <br /> LEGAL DESCRIPTION(see tax receipt) 101: z/ C 6 MV 21D LE �1 C, <br /> 7I� iN Ah; Ah.) 40V L.o1 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE IDI ADDITION ❑ Q to o <br /> TYPE OF PERMIT(S): .�a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n (^ <br /> STRUCTURE/ADDITION USE: V/t•/t G G y <br /> o Q> <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) rn � <br /> m <br /> BUILDING CONTRACTOR: ©w Ai E/Q <br /> m � � <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN SY:X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T 3 <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING- (AERIAL OR TOP VIEW) A <br /> O m <br /> m a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE o p <br /> m 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 J 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. 1 �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. Q <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS C>Q 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> t <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN0 <br /> NEEDED. g <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o <br /> 1 t <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. 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. <br /> m � DOD <br /> iO <br /> 6. m a F m <br /> m F3 am xa '^ A <br /> 7. o = 3 <br /> Z c m o c 1 <br /> m Tom : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Lj N D <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of m 2 C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <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 relying on this information I ami i I oOi o <br /> providing In this application. 1 agree to permit county officials charged with ad r v fm <br /> authorized person to have access to the a ova described premises at any reason t r s i ' [ <br /> SIGN HERE _ 'o° `: n <br /> v a : <br /> (sig ur of own r iltling contractor) A� folio ( .n. o <br /> G . <br /> A vV � <br /> ZONING ADMINISTRATOR lJ) <br /> 06 <br /> BURNETfCOUNTY <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> ZONING <br /> SUIS PERAI�IT SHrl_ EXPIRE EON Y A FROM TE OF ISSI�ANCE <br /> Miry) L }U arnRS UISoh <br />