Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator � o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N O� <br /> OWNER r le ne L2r�<l'aJ TELEPHONE ������� .Sd 17 w <br /> ❑ p <br /> HOME ADDRESSDC�U r S La ke l"� O <br /> �` v v Y o <br /> r � <br /> h 0 <br /> EMERGENCY/FIRE NUMBER(���, ROAD NAME f l 'V; 15 <br /> r� of' // 2 nsens LAAPSVIDIdt P/ v <br /> LEGAL DESCRIPTION(see tax receipt) 1.Of S A71 Z �� ( L� - 0164, r" 1ofs j d 3. of bI6c1C <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION A PRIVY ❑ <1 <br /> �r U) o' <br /> TYPE OF PERMIT(S): sss...YYY <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: po rC-h <br /> (Home/Cabin; ommercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: DIJ (00-97-t llCT-7 to 17Z'. <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81AX 11 SHEET OF PAPER. ANY INCOM LET OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. "n <br /> L �f� z y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) S�/ `n^u//l %/ p CD <br /> �(/ b On n <br /> .'k <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 1`14I 0 ❑ Z <br /> C) v � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> n <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 <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. O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N 'h' <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS O <br /> MUST BE SIGNED AND DATED BY THE OWNER. --I <br /> ) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a O ^� <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 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. <br /> C w 0 ( n 77 <br /> ° m <br /> 6. m 3 nm O ncD <br /> N C y fn O_ j' 3 <br /> 7. w CD o 1 <br /> O <br /> cn" pI 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 m 0 m <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- <br /> G) : <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 <br /> authorized person have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m <br /> m : <br /> SIGN HERE <br /> (s' siful e oil own e ilding contractor) I (bate) <br /> ZONING ADMINISTRATOR <br /> - <br /> (P'P�9j <br /> � d U,0. <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />