Laserfiche WebLink
Bt:rnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -CD o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 ,) <br /> ,A O <br /> / -t /�/ ,r' '`/ j� /J /� rip C d <br /> OWNERTiGO/yJ�S' V-/ - ,4 C7 /!fT�i�G/C TELEPHONE ��S'�, 6 2 ^5��� v <br /> ,[ ( <br /> m <br /> n <br /> /�' J q <br /> � <br /> HOME ADDRESS `�� / O 1.(..�/� �QGC, pl'e o <br /> EMERGENCY/FIRE NUMBER 7 ROAD NAME COUN711 z/NE kA <br /> 1 aa S <br /> LEGAL DESCRIPTION (see tax receipt) /JE -S '� a,� J�= q•3�7 cc• <br /> DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ <br /> TYPE OF PERMIT(S): V <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ O a' <br /> STRUCTURE/ADDITION USE: / / Q m e' 0 lI i <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) rn 1 r <br /> m <br /> BUILDING CONTRACTOR: 46®NC,1.0-4 Ria C 7%K <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/1 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 F i <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m V <br /> M y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O Q <br /> n <br /> T 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 /> C o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m /,i 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF o <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. N <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO d <br /> BUILDINGS, ROADS,LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. � N L <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. T <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 I <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> S TBACK AREA. <br /> 5. <br /> CD 0 CD CL am <br /> � � 3 'am xa = .� <br /> 6. CD C s m 0 <br /> Z w o 1 <br /> 7. o <br /> _ Cn : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> 0 A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofn a <br /> N- <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize ` ' <br /> PP ( 9 Y ) 9 m p <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- �' cj <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett relying on this information 1 am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above descr'bed pre as at any reasonable time for the purpose of inspection. -n <br /> m <br /> m <br /> SIGN HERE <br /> (signat ner or building contra^ (date) <br /> ZONING ADMINISTRATOR <br /> �I CQh <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />