Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administra�to"rj -U 'c0�i <br /> APPLICATION FOR LAND USE PERMIT `7 � 3. <br /> y O <br /> gsx �8i ysCD <br /> OWNER �Osd�ZAS _�'/Y A G TELEPHONE 7i s , 6 S _ G7L! o <br /> � <br /> HOME ADDRESS �/ <br /> � woo AN snov,�� �/�( , sql / <br /> r m <br /> EMERGENCY/FIRE NUMBER ROAD NAME1�l) 1 0 <br /> tusk 129/ D, 82� <br /> LEGAL DESCRIPTION (see tax receipt) <br /> DWELLING/BUILDING ❑ GARAGE//ACLCESSORY STRUCTURE ❑ ADDITION ® PRIW ❑ I N 0 - <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> n <br /> STRUCTURE/ADDITION USE: t7A 4y / lG4dey UYL— &Y nc q <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> m <br /> BUILDING CONTRACTOR: <br /> m <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/z X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m ��� <br /> O <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n o <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N), c 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 3 <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. o <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. ' , p <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N D <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. alo S. a <br /> 0 I� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a o <br /> NEEDED. aUy <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW, Z <br /> CONDITIONS OF PERMIT: o (� <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 smokELINE;'i O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALi -! , <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE,REQUIRED WATEk' - <br /> SETBACK AREA. n� i <br /> 5. <br /> mid ° o °af m <br /> 6. <br /> �``' / (OD 3nm0, ° m ,'0 <br /> 7. p m c � o 3 <br /> Z CD <br /> U) AI declare that this application (including any accompanying schedule) has been examined by me and to the best of my c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy ofCL b <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize M m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- U+ <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am im <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above d cribed premises at any reasonable time for the purpose of inspection. m <br /> m <br /> SIGN HERE - <br /> �i -a� <br /> si ature n r or buildin contractor <br /> 9 ) (date) <br /> �E <br /> ZONING ADMINISTRATOR .O <br /> O' <br /> TOWNSHIP PERMITS MAY BE REQUIRED �� <br />