Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N <br /> N <br /> OWNER�� l,/V "� TELEPHONE <br /> CD <br /> HOME ADDRESS U�y i ' S W ^7 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt)g� IXd y3s/sgy>�S,ys- 3�t�a�/�'i������s- y V <br /> DWELLING/BUILDING ❑ 1►GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ <br /> TYPE OF PERMIT(S): /LXl /6 -36—d D3 j� p <br /> FILLING/GRA I G 1:1 CAMPING UNIT ❑ SUBDIVISION ❑ /y r- N / /9 601 <br /> n <br /> STRUCTURE/ADDITION,USE: o <br /> (Hom(;/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: XAJO '� <br /> m <br /> T <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR CD3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m - <br /> O <br /> X N C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> CD <br /> -n Q _. <br /> TZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n a � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). y <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. qzq r o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO t <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 3 <br /> f <br /> O � I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. pp�� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY f^' <br /> PERMITTED. X, (� \I <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER Ijef,_ <br /> SETBACK AREA. r p � 1 <br /> 5. <br /> s. <br /> s yn Iti/ Tep-7)c This structure to be used as private residential m -D 0 r > o a f m <br /> garage/storage only. Not to be used for human o � y N <br /> habitation. Z N ID 0 ' <br /> o Tom : m <br /> - cn: <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of n <br /> all information contained in this application(including any accompanying schedule)and I further declare that i recognize Q� 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 /> O : <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 N <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other �! I <br /> authorized pens.gW to have access to the a4qve described premises reasonable time for the purpose of inspection. m <br /> m <br /> m <br /> SIGN HERE <br /> (sig o caner or building contrac' (da e) <br /> ZONING ADM ISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />