Laserfiche WebLink
-o <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> 0 (1 <br /> OWNER .DrT R F L L ► R/4YC f•?L-F 7 TELEPHONE y6 3-7- <br /> 0 <br /> m <br /> CD �.. <br /> HOME ADDRESS 2-41167 AlO r W ILLl4M S, "fi-AIT SQj/l2 G- v G <br /> d <br /> EMERGENCY/FIRE NUMBER 2,`f 1 6 7 ROAD NAME n fo-� �I L Lb+M S <br /> LEGAL DESCRIPTION(see tax receipt) Z-Z-SSO 7-O Y-2,&5 2-38=!8 -07- O ) <br /> C' <br /> DWELLING/BUILDING ARAG /ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ Cn <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> STRUCTURE/ADDITION USE: M E- lY�l K�Tv-C ° 1 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m = J <br /> BUILDING CONTRACTOR: S ELF iv <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR � 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O _ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) (W N G KE 17 S; R r*Cff9--P) o n <br /> Z 4Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINGp <br /> S)TO m os 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. P <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 <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. 1 <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN q <br /> NEEDED. -)(, Zolle.— Cq tt-eNTII/ GC \ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. (���� �I o <br /> CONDITIONS OF PERMIT: / � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. F1 Nj <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY W 9 <br /> PERMITTED. CIO V <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> TBACK AREA. CD CD m <br /> 6. /� //p /CXCC/1 �L //(Q pp2 9 a y y o • 3 <br /> lCn m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �/�1 L7 2 IS <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I 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- <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 /> P 9 � PP� 9 P tY 9 9 tY <br /> authorized person to have access to the above desc ibed premises at any reasonable time for the purpose of inspection. m207C <br /> m <br /> SIGN HERE J Z 2 2 w <br /> (si re o Ilding cont cto ) � (date) <br /> ZONING ADMINISTRATOR / <br /> '1 N N En N H Vt N <br /> N ?A410 V7 O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 O 0 O 0 <br />