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 /> L �kr49 Sc)- 4Sa c o_ <br /> 7 /S _ m <br /> OWNERSS rfah� TELEPHONE Z — 8 .2C/ —/el� a �' <br /> Lel o <br /> I <br /> S3 ^ S mils , �� 4tr.t. s- s 1-i1 7 <br /> HOME ADDRESS J3�/� I P,q�Lk i�1 L` , O , <br /> r m <br /> EMERGENCY/FIRE NUMBER a Z/ 7 9 ROAD NAME Ow / /{� vv( p)o <br /> a <br /> LEGAL DESCRIPTION(see tax receipt) C ! A/ — (/ L O m <br /> a <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ CO 0 <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ < <br /> ^ Ui <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin, Commercial Business; Bedroom;Deck;etc.) U <br /> BUILDING CONTRACTOR: l U N tl w �)/✓S [- A./ Eu <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p w <br /> �I N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <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)OFo <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 I <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 t ;. <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Cr o <br /> NEEDED. <br /> Q <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 /> 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. p , <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER 1�J <br /> 5 SETBACK AREA. > �� , �S �.L/� <br /> CJXa CChz� — ;a 0r, o�vv <br /> O '7y This structure to be used as private residential a 1` c 0 y o 3 <br /> s. garage/storage Only*y Not to be used for human o i z <br /> 7 habitation. <br /> =tn: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the oest of my G1 ' ID <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy ofo E! <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- d O <br /> sue a permit. I further accept all liability which may be a res It of the County of Burnett relying on this information I am <br /> providing in this application. I agree to permit county offs als ed with administering county ordinances or other m <br /> authorized person to have access to the above described pr onable time for the purpose of inspection. T <br /> M <br /> u <br /> SIGN HERE ��^' �J <br /> (signatureofow ro building acro G Ir. (date) <br /> ZONING ADMINISTRATOR 1 ` ` ` . <br /> NF N N U N N f T(n <br /> fT VI O (n tl1 O O <br /> TOWNSHIP PERMITS MAYA E O <br /> Efl _ 0 0 0 0 0 0 <br /> //VG /prT�ty <br />