Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS _3_ <br /> r <br /> m V <br /> OWNER C� t1/QD I/dFRM' TELEPHONE7/9 p 177 <br /> HOME ADDRESS J��Lf IS�y AyF� R/CE LA{�f6� (rirSG' Sr/�r� 3 <br /> r � <br /> o <br /> EMERGENCY/FIRE NUMBER �7�'3Q ROAD NAME �`L OrgD <br /> L' o T 1 CSM <br /> p1 P <br /> LEGAL DESCRIPTION(see tax receipt) GGfi�` LOT q� S'&,-r/oN ?moi r T WN lel i/lt✓ lVtrCD <br /> �1 N <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE-9 ADDITION ❑ PRIVY ❑ ' ' y o' <br /> TYPE OF PERMIT(S): CrQ <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: 0_ <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) N (A <br /> BUILDING CONTRACTOR: jQErtcAclS <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Y:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> O r <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O CD Q <br /> n 0 <br /> 0 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(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)BUILDINGS)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o � <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN T E 1` <br /> NEEDED. M <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> I <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 /> � m � m0Cfm° 0.6. / � O <br /> 'O ry C N m O <br /> 7. Z : '^ mo <br /> 0 . -n� .� <br /> = c^ pI declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 0 m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize po 11 c <br /> CD <br /> that this information I am providing will be relied upon by th ounty of Burnett Wisconsin in determining whether to is- N Lj <br /> sue a permit. I further accept all liability which may be a res County of Burnett relying on this information I am m <br /> providing in this application. I agree to permit county offic ministering county ordinances or other <br /> authorized person to have access to the above described pr a for the purpose of inspection. m <br /> T <br /> (D <br /> (D <br /> SIGN HERE 69 <br /> (signature nor buildi ctor) VUIV / (da ) <br /> ZONING ADMINISTRATOR L7 6 <br /> T WNSHIP PERMITS MAY� 4O4etl Y <br />