Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> F o <br /> OWNERS4,f Q >n , �TELEPHONE _G1yAr+y , Qu AN III., o <br /> CD <br /> HOME ADDRESS aS 1 3 E — f Ave 96 St. PA..t l _ Yh fv S_n 0 9 O <br /> CDCD <br /> r r <br /> o <br /> EMERGENCY/FIRE NUMBER ROAD NAME 6:p,z t;F N <br /> 1 <br /> P <br /> LEGAL DESCRIPTION (see tax receipt) ..5C5-C_ 3 3 3 y // �7 �/ k,) ` WAI 1� r� <br /> �S' / r <br /> DWELLING/BUILDING K GARAGE/ACCESSORY STRUCTURE 5?_ ADDITION ❑ PRIVY ❑ o <br /> TYPE OF PERMIT(S): Q ' <br /> c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ o. <br /> // y W <br /> STRUCTURE/ADDITION USE: luo Mr O 1 , <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) W <br /> BUILDING CONTRACTOR: Alxel f n /Ga-& (6 ly&- S v' <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR - <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. TO ^ \J <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> TI <br /> ,n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n w �o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m a <br /> NORTH(N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m CT� `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. <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 (� <br /> MUST BE SIGNED AND DATED BY THE OWNER. ) <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. a <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: 0 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q/ <br /> ISSUANCE. 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Q <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. C <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER l� <br /> 5 <br /> SETBACK/jRE(A. <br /> 6. / (OD 3nmOa E ;U <br /> 'O C N 0 O <br /> N N O O <br /> 7. CD <br /> O T� it <br /> _ cf): m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my D <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ` <br /> : � v <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue apermit. I further accept all liability which may be a result of the Co u o n ion I am <br /> providing in this application. I agree to permit county officials charged e S r other o <br /> authorized person to have access to the above described premises at any r r bh o,eg(i sp ction. m m <br /> ID : <br /> CD : <br /> SIGN HERE <br /> (signature of owne r bullding contra ) f — �wate) j. <br /> ZONING ADMINISTRATORWWI <br /> /G <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING <br />