Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -10 G) Z <br /> APPLICATION FOR LAND USE PERMITS CD_ ° <br /> ('da 0/0 vrw O <br /> r 0 <br /> 4--Z 5o3� <br /> " <br /> OWNER ,e TELEPHONE = L Z °' <br /> G� o <br /> 4. <br /> MAILING ADDRESS . o <br /> 1 /6 Q V1 0 <br /> � <br /> m <br /> / <br /> PROPERTY ADDRESS ea <br /> LEGAL DESCRIPTION(see tax receipt) ! �U) <br /> �.m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION C o' <br /> TYPE OF PERMIT(S): rr o t <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: o� �-AC / yTp� KzalLn0A'k. <br /> vJ <br /> (Home/Cabin; Co mercial Business; Bed9om; Deck; etd.) U) <br /> ��' <br /> BUILDING CONTRACTOR: J�/�6 O� �� <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O 3 <br /> A C <br /> t3"1I()NS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) 0 a <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. z <br /> n T O C <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m o3 0 <br /> CENTERLINE OF ROAD,(C) BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF a <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 2 <br /> BUILDINGS,ROADS, LAKE,LOT LINES. d <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 D� <br /> MUST BE SIGNED AND DATED BY THE OWNER. { <br /> o <br /> ` O � <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. (� N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. -1 z (� <br /> CONDITIONS OF PERMIT: P i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> O <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 J <br /> PERMITTED. pp <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER QN <br /> SETBACK AREA. G <br /> 5. <br /> A m 0 r D 0 D 0 -0 <br /> 6. m C Ol d 0 (p O. :E m <br /> m x 3 n mQ� <br /> 7. o N C y N O 3 <br /> P N -n< : . . it <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 <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- ° 0 cn <br /> m <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 (�y : d o <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other <br /> authorized person have access to the above described premises at any reasonable time for the purpose of inspection. <br /> CD <br /> SIGN HERE n <br /> gn ure of o er r building contractor) (date) o <br /> 0 <br /> ZONING ADMINISTRATOR <br /> O N Vol W W N O <br /> [(�C� <br /> TOWNSHIP PERMITS MAY BE REQUIRED o u, O 0 cn 01 o <br /> THIS PERMIT SHALL E PIRE ONE YEAR.FROM DAT F I SUA CE <br /> mat led W`Hi -) 1e4-�r -to VL! 1�L � �.n�l�ng <br />