Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v ci Z <br /> APPLICATION FOR LAND USE PERMITS 3 P <br /> J(�5,5�5 ,^ 1 c l ,,�A�UN 51.P C(oli�2�'Fptr II- �{G3473 'l A� <br /> OWNER NAwI�Gp-�dIJQlu, VAXIS kor''` 'ss '*EPHONE��ST� &(9-4J !3 <br /> nn <br /> HOME ADDRESS �JJ L CD _ Rd.. C- )A r O. 54830 <br /> EMERGENCY/FIRE NUMBER (6 539 ROAD NAME <br /> t���p <br /> LEGAL DESCRIPTION (see tax receipt) �� / G f? 3 4— (4O'_�� W <br /> C <br /> CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION CZ PRIVY ❑ CO > <br /> TYPE OF PERMIT(S): it <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: H o r11 c, Q 9- - 'f"(1 AaAt-ff�� o' <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) U) ~ fT <br /> BUILDING CONTRACTOR: � <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n <br /> 3 y� <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ` <br /> O = <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T o. <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <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. -.Q o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO I <br /> BUILDINGS, ROADS, LAKE, LOT LINES. I, <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. c �� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> a <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I <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 Q <br /> PERMITTED. b <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER I <br /> SETBACK AREA. cc, t7 cn ,` <br /> 5. <br /> Avn�' � � DnOm <br /> 6. m a m <br /> 3 a m x M ru <br /> to C vi : O j 3 <br /> 7. Z : C ;2 O <br /> O X <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j c rj <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m c <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- p <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to hav ac ss to the above desc 'bed premises at any reasonable time for the purpose of inspection. m <br /> m : <br /> CD <br /> SIGN HERE <br /> (sig ure of ner ar buil 'ng contra r (date) <br /> ZONING ADMINISTRATO <br /> Fn cn cn cn ui ui <br /> N(T N N(Jf [T <br /> (T OIO(T CnOO <br /> T INISHIP PERMITS MAY BE REQUIREDo o O o o O O <br /> � �� 0000000 <br />