Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 0Z <br /> APPLICATION FOR LAND USE PERMITS <br /> 0 U <br /> f/1 <br /> OWNER ��� J� TELEPHONE <br /> �j <br /> HOME ADDRESS <br /> 513 <br /> � <br /> m <br /> EMERGENCY/FIRE NUMBER 1 3 ROAD NAME/4), &prJn`r1All n� <br /> LEGAL DESCRIPTION (see tax receipt) :5211 /7"/O/R15W /-d-_1cs1r? v q p 39ff <br /> Go ,tvf3 I rn <br /> CD <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE rgL�]I ADDITION ❑ PRIVY ❑ Cl) 0 <br /> TYPE OF PERMIT(S): <br /> Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ O-°' <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> m <br /> BUILDING CONTRACTOR: &#fe- <br /> CDm <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <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 m �° <br /> NORTH(N). C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO rn 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 0 <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. I (� <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 0 / <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN 0 <br /> NEEDED.) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o l <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> EMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHOR <br /> 3. RATIONS ARE ALLOWED UNLESS SPECIFICAL 7 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE U ED A4 <br /> SETBACK AREA. <br /> 5. //� , �.�}f <br /> �UI G� S'"�'�C.'t 11�Q. Llt�G.. �'4r'e' _� ` 2002 II m M. d m 0 ( n f m <br /> 6. r leaeYV101�Ci1 a� 1 C�IG�ve_ CL'L �9A)e- uljo IYI a UFiNE7 COON CC. y y o j 3 <br /> 7. r zpIVI1VC N o T <br /> - a' : ` A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my (\ G) : c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of 1� 0 0 : I m <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize O <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 (QAj <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other 7.1 <br /> authorized person to have access to he above described premises at any reasonable time for the purpose of inspection. m <br /> � : <br /> (DCD : <br /> SIGN HERE yr <br /> (signature of eroctor) date) �! <br /> ZONING ADMINISTRATOR <br /> TO NSHIP PERMITS MAY BE REQUIRED '7�7C <br /> L <br />