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 �. <br /> " E <br /> y ^ � <br /> C �V <br /> N � <br /> OWNER /�7+1f �A TELEPHONE���'9�'AKIO n W <br /> h (DO <br /> j%//� <br /> MAILING ADDRESS ALeL�' L/1(� GtJ�fI ✓/ /1 , SSIID <br /> � r <br /> /I? ( N 7S 0 <br /> PROPERTY ADDRESS 2,2 6.21 4Ch,=R4,e k )?,0� -�4AW4, a <br /> ( p) X1G LM vlv� p /�! 3 -3� <br /> LEGAL DESCRIPTION see tax recei t07 m <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE V ADDITION <br /> TYPE OF PERMIT(S): -rl <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION vFCk H <br /> STRUCTURE/ADDITION OSE: W 7Lb o <br /> 0 <br /> �jt d �'QS .F Be(Home/ bin; Commercial Business; Bedroom; Deck;etd.) d <br /> /"/L , \ <br /> BUILDING CONTRACTOR: � c eiF1/�,4 0 X(lk,0 /1 C <br /> 'o <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81A X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O " <br /> 77 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T o <br /> 2! o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m e ^C � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> Cq o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF ^ 66 o <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 ►c\ <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 2 <br /> MUST BE SIGNED AND DATED BY THE OWNER. f I <br /> v � p <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a 0 h J <br /> NEEDED. 0 <br /> C` 1 � f,' <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. �J o Co w <br /> CONDITIONS OF PERMIT: p C <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. !VO tN,s -u.((ecl 1,.. IIuxk Hcw� n m m <br /> 6. f UU m. 3 a m x 3 <br /> Co <br /> N <br /> 7. N '!` m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m — 2 0 <br /> PP ( 9 Y ) Y Y G) r <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of V 2 a a i v 70 <br /> , <br /> -• : cn . <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o rn <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to have access to the abovpr described premises at any reasonable time for the purpose of inspection. oCD <br /> C <br /> o m Q <br /> SIGN HERE (y <br /> Ig ure g0wrjer or building contractor) (date) a <br /> ZONING ADMINISTRATOR ' <br /> pin in ro <br /> a0S' 3q /t� �( 0LnCA <br /> 10 <br /> TOWNSHIP PERMITS MAY BE REQUIRED f3/ 7'7-_ � _ <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE a L z ��)h`f>/4 <br />