Laserfiche WebLink
Oq <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -o c) Z <br /> APPLICATION FOR LAND UpE PERMITS 3.° <br /> r <br /> _ • fI � �►— N -� <br /> s — I18 'k W o <br /> CD <br /> OWNER J .(}of V py rY n ��(yU N TELEPHONE , I }L, 1, " y O "7 7_ o <br /> d <br /> HOME ADDRESS bLc� J �-c �-✓� -4 . —.� n ,, ° O <br /> r � <br /> - o <br /> EMERGENCY/FIRE NUMBER ROAD NAME yV\ v S e r /��✓z <br /> -t-40 " 21 <br /> LEGAL DESCRIPTIONt see tax receipt) Z< 3 t� W <br /> ( P) La i� G S +�`'� !f_ Q" (�- l (9 0�T LOT S Z ci m <br /> 1 m <br /> DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ Ch C <br /> 0 <br /> TYPE OF PERMIT(S): rr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a , <br /> ,( S. Y . <br /> STRUCTURE/ADDITION USE: 3� t}(A,o� / �©i Dre� 0' <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) Cn <br /> BUILDING CONTRACTOR: S e <br /> CDv <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n — <br /> O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p Q O <br /> T 4 <br /> In Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C :° <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m t 1 ) 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF (/1 0 <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 <br /> BUILDINGS,ROADS,LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. CN) N 2kl <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. e <br /> U3 <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN m S, <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. r , <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. w <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 /> 5. <br /> ETBACK AREA. <br /> CD— W Daov <br /> 6. m6< B am 'ca <br /> a m C'm <br /> o M <br /> = N : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j ID <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 E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> m : <br /> M : <br /> SIGN HERE Z O O <br /> ignature f weer or building coqirl to) (dat ) <br /> ZONING ADMINISTRATOR <br /> <nt»t»f»fnv+j' <br /> N N (11(nto 9ON <br /> 0 <br /> (T ONtn <br /> NSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />