Laserfiche WebLink
C97� 6&np, <br /> 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 /> r <br /> v y O <br /> N <br /> OWNER �p f TELEPHONE 715 V 7a a!Iy CL <br /> v <br /> HOME ADDRESS �r6 Q2 9 02 TS 1(.� <br /> EMERGENCY/FIRE NUMBER rte- ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) Lo* 7 <br /> Sec•/8 T38/V rt /� . �0 <br /> DWELLING/BUILDING $ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ElyZii <br /> TYPE OF PERMIT(S): �ry 0 <br /> FILLING/GRADING lj�l CAMPING UNIT ❑ SUBDIVISION ❑ 1 L M. 1 <br /> STRUCTURE/ADDITION USE: C4±6 l N <br /> (Home/Cabin, Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: FUAleleA Ro tleA-s ? v l <br /> G,' <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n 3 <br /> O ir <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> O m <br /> CL <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 o <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m ^�. v <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF (✓ <br /> ' Z <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., ETC., <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTORTHE PLANS N <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 17 0 <br /> NEEDED. Cr <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT N <br /> ISSUANCE. <br /> ZV. 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. <br /> -V0r /vokjrn <br /> v 'O <br /> 6. o C. m m � <br /> N `G V G.fry ' I' <br /> 7. <br /> Z E m �� ° <br /> 0 M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G3 yi m <br /> c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of � m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <br /> that this information I am providing will be relied upon by the County o u, Wisconsin in determining whether to is- E L7 <br /> sue a permit. I further accept all liability which may be a result of- m <br /> providing t tt relying on this information I am m <br /> p gin this application. I agree to permit county officials charge ifl� h(n i^g county ordinances or other <br /> authorized person to have access to the above described premises aCD <br /> t any reasonab a e r the purpose of inspection. <br /> m <br /> SIGN HEREe 16 y <br /> (signature of owner or building contract C -4 <br /> Ida <br /> N (da <br /> ZONING ADMINISTRATORCOUA, <br /> m to cn to Cn <br /> N NIT N N N (T <br /> N (JI O U1 I11 O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 ' 0 <br /> 00000 0 <br />