Laserfiche WebLink
6y"w <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator _U 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N 0 <br /> N <br /> OWNER C' e \/ ' ���Y� / TELEPHONE <br /> CD <br /> HOME ADDRESS Pk, 5 / 1 oe � <br /> � r <br /> EMERGENCY/FIRE NUMBER a 8 8 s ROAD NAME <br /> �7 T 1 <br /> LEGAL DESCRIPTION (see tax receipt) SE'C 1 �1 V 6 Aallgc 17 L o Y 8 O <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE X ADDITION ❑ PRIVY ❑ (n <br /> 0. <br /> TYPE OF PERMIT(S): ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: <br /> nor k 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) Cn <br /> S�-eIs C 1 �'oh s Lr �-�'�w <br /> BUILDING CONTRACTOR: d <br /> 12 <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81A X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n <br /> O <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n Wo X <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :° <br /> NORTH(N). y o <br /> 3 . SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES,(B)BUILDING(S)TO m D <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. 0 <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 /> 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. F <br /> � ' G <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. IYJ� <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. <br /> X _020g b> CVCL A> <br /> f m <br /> 6. m 3 a 0 FL.m ,"0 <br /> -o me <br /> in ID <br /> 7. o -nM <br /> cnA <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m O : m <br /> all information contained in this application(including any accompanying schedule)and I further declare that 1 recognizeCD 0 <br /> d <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> 0 : <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 /> 1 : <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. . .� <br /> M : <br /> (D <br /> SIGN HEREl ' /���_��1 0I <br /> i'gnatuM�re o wner or building contractor) —� (date) T <br /> ZONING ADMINISTRATOR �J I <br /> TOWNSHIP PERMITS MAY BE REQUIRED /� � <br />