Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Admini ator iA a o Z <br /> APPLICATION FOR LAND USE PERMITS <br /> r <br /> OWNER TELEPHONE --C1,&)3 o <br /> ,1b�w� Ql�a��lr�. �iP�� - sCD <br /> a � <br /> HOME ADDRESS JLI � �J :Ss <br /> EMERGENCY/FIRE NUMBER// �` Z 7 / ROAD NAME AL <br /> LEGAL DESCRIPTIONt see tax receipt) / I / r� <br /> ( p) ?) o+ CLJ� U. �//h 1" ,�i�7 +s �OCJrtS��!°(� �t/'��� G CD <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION 1:1PRIVY El (n cn 0 <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑f CAMPING UNIT ❑ SUBDIVISION ❑ � n <br /> STRUCTURE/ADDITION USE: V 4/ '? a �C �i / �D 0 <br /> ro /Cab' Com r ial usinfess; Bedroom; Deck;etc.) m 1 ,� <br /> ll/ ( <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 77 SHEET OF PAPER. ANY INCOMPLETE OR T 3. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> °z <br /> �� <br /> �Ul�� UI��Vl _ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) �// ?`Z7 O a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m CD , <br /> NORTH(N). W w 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m vl ) <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. 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. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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. o <br /> o� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <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 7' <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> CD v n : <br /> 6. m � 3 'am 0nm �\ <br /> 'OT : fD C ,Nj, N O J 3 <br /> N N O O 0 <br /> 7. O T, <br /> v : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my A <br /> knowledge and belief it is true,correct and complete. I acknowledge that i am responsible for the detail and accuracy of a �. <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize C <br /> PP ( 9 Y 1 9 D (Dp <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> 0 : <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 D <br /> providing in this application. I agree to permit county officials cha?g i ring county ordinances or other <br /> authorized person to have access to the above described premises; m, s1 bie ti urpa a of inspection. ,i ; CD <br /> SIGN HERE / <br /> (signature of owner or building o ract 9 � I 1 date) .'{ i <br /> ZONING ADMINISTRATOR !10A ✓ O . . . . . A� <br /> ;.yy4lr COUNTY g <br /> TOWNSHIP PERMI S MAY BE RE MIC <br />