Laserfiche WebLink
Burnett C-Junty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator r/07 c) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N � <br /> N <br /> C <br /> q nl <br /> OWNER X4 ( c-t4 }fI M ETcAl f TELEPHONE 763 389 SO /J n <br /> O <br /> m <br /> HOME ADDRESS P Q 13 a x 9 2-3 P/QINC C-Th J M N Z r3 7/ .. <br /> r � <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> T6wN6F 6Ak0- (oN(r -t+AYDEW LAKF OE✓F1oofOKENr Lor <br /> LEGAL DESCRIPTION(see tax receipt) 6 evT Ler 3 $i $Eri4 SW r/r SEe• V 'Twp 4a N RANGE f6 W c <br /> CD0 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE Z ADDITION PRIVY rn o <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �' <br /> J N <br /> STRUCTURE/ADDITION USE: t7 Av SNECT E(Z �tT t� <br /> (Home/Cabin; Commercial Business; Bedro m; Deck;etc.) m J <br /> m <br /> BUILDING CONTRACTOR: N6,cTHW e t Ax C,rTe NE 6A CE Wr) <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81Fi X 11 SHEET OF PAPER. ANY INCOMPLETE OR In 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p rr <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 4 M <br /> 2! o1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATENORTH(N).3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES,(B)BUILDINGS)TO mCENTERLINE OF ROAD,(C)BUILDINGS)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF ZLAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <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. n o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a <br /> NEEDED. c-1 � <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: 1 <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. r , <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER w <br /> SETBACK AREA. <br /> 5. V'� Mvnd o�orn <br /> CD m <br /> 6. m � 3am CL <br /> 6. <br /> N C io M C <br /> Z N N <br /> 7. o <br /> =Cn : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my , c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of � m o <br /> 9 P , P Y o. E E <br /> all information contained in this application(including any accompanying-pcheduleyAnd I further declare that I recognize Qi ' m m : i m <br /> that this information I am providing will be relied upon by the County of Burnett Wi,�gyf�in=tn'dWwrmining whether to is- �: a <br /> sue a permit. I further accept all liability which may be a result of the County of$urnett relatingQh this information I am <br /> providing in this application. I agree to permit county officials charged with adminlstering!cduhky ordinances or other m <br /> authorized person to have access to the above described premises at a onable time forthe purpose of inspection. -n <br /> Ifm : <br /> M : <br /> SIGN HERE /0 hug 2001 �' <br /> (signature ner or building contr or --,,, (date) <br /> 1 <br /> ZONING ADMINISTRATOR ' cn <br /> f»wtntnFnw-� <br /> N VtNNN Vt <br /> ^u• p1 O fT Cn 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> �yo 000000 <br /> 01 <br /> Y e �`��'1 <br />