Laserfiche WebLink
� �Z <br /> INRett4ounty 7410 Co. Rd. K, Noo102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 (� <br /> N O J� <br /> n <br /> OWNER ,�/7 ��✓✓/' F.��'r TELEPHONE <br /> �� <br /> HOME ADDRESS � s o�� ��� � <br /> / <br /> EMERGENCY/FIRE NUMBER -,2 -17 ROAD NAME ho�N u✓F� (�I ' » <br /> LEGAL DESCRIPTION(see tax receipt) 7 �3 _� ll 1 rn <br /> XX%��� m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIW ❑ m <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING El CAMPING UNIT ❑ SUBDIVISION y <br /> STRUCTURE/ADDITION USE: /�—Gt✓G�� — 'V o <br /> ( me/Cabin; Commercial Business; Bedroom;Deck;etc.) c <br /> BUILDING CONTRACTOR:_ ) <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 — <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 c <br /> O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m M <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. <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. `z Q <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 /> o � + <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHENa ° l <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z W <br /> CONDITIONS OF PERMIT: c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 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 /> 5. <br /> O L O <br /> 3 CL <br /> a <br /> 6. 9N a- <br /> 9 ocw 053 <br /> Z N f D .q : 'O q <br /> 7. 0 : <br /> U): m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of �� m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 to <br /> authorized person to havemF±n to the above described premises at any reasonable time for the purpose of inspection. T <br /> m <br /> m <br /> SIGN HERE -Z <br /> (signatu <br /> #�!qw-nWvr buildin tor) (date) (� <br /> ZONING ADMINISTRATOR rCJ <br /> AS N(TNN49 V1 <br /> V1 [T O0O00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED o <br /> 0000000 <br />