Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> UT o <br /> �� � 1 , ' ( �rrpAye� J— (J <br /> OWNER 1 1'LX. W \ YV��55 , U1�l7S� P'JTELEPHONE 7 3Z7—O570� <br /> HOME ADDRESS 2 O 9 7 5P► rC r la� e-c( W pl/?de i( UI o <br /> EMERGENCY/FIRE NUMBER ROAD NAME S � (� <br /> r r, Cn <br /> LEGAL DESCRIPTION (see tax receipt) ( �� S(� r ,� 18 lz�).o <br /> 1:1 GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ Cn <br /> _1(� <br /> DWELLING/BUILDING v/C <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 2-)( a <br /> STRUCTURE/ADDITION USE: 1�N50QMU Q7lrPe tlt I�wr1 t1�r2 4�LO bl6l� dK�+� (A 5e- 1 J o' <br /> (Hom C bin;-7Commercial Business; Bedroom;�D(eck;etc.)/ / <br /> BUILDING CONTRACTOR: -Wf""A\ TL r ,LI <br /> u-is tM!V^ ,41 'I—V'hdtV-y5 <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 33 Qe <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 N `W <br /> C v <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n $ <br /> m O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). CO) O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m3 <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 O <br /> BUILDINGS,ROADS,LAKE, LOT LINES. <br /> 5. 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 0, o <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> � � I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Cr <br /> W <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <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. <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. I GC (�t- /U� 1—1 B lac W rna i.. �ctb.+,a �7 v m m d 2io ��0 m <br /> 6. OI— � Ur� �. crPcsiF r� �P./n�O /LLCM�lo15 Ur p6Pt�kT/J•� 3 c 3 <br /> Z : CM0 <br /> 7. Pm : <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my3 c O <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a Lr <br /> all Information contained in this application(including any accompanying schedule)and I further declare that i recognize C^ m : m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is m C <br /> sue a permit. 1 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. <br /> m <br /> Ct <br /> SIGN HERE <br /> (sig ure f owner or bu i contractor) (date) <br /> ZONING ADMINISTRATOR fn t»w f»Fw cn <br /> N N(TNN V N <br /> (T N O Vn V1 O O <br /> O 0 0 00 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 00 0 <br />