Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 C) Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> /� � rc3-/-�53-8112 a o � <br /> OWNER l �rj <br /> �) j ao-e2oe r'ne [l r ling TELEPHONE 7x -3 419 AW 0 <br /> m <br /> HOMEADDRESS3494 gjfiiF 33k2 o <br /> EMERGENCY/FIRE NUMBER ' <br /> ROAD NAME <br /> M� Q � � I� <br /> LEGAL DESCRIPTION(see tax receipt),(6 f l� "�UU� c►l ���I OCD <br /> r� <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ® PRIVY ❑ tc 0 <br /> TYPE OF PERMIT(S): Q <br /> FILLING/GRADING ❑ CAMPING U IT ❑ SUBDIVISION ❑ r <- <br /> d Gxr l y_ <br /> STRUCTURE/ADDITION USE: 5 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) CO <br /> //�� <br /> nn <br /> BUILDING CONTRACTOR: Fess e6ks4-h'!IA_rAK — hl�AIIF Ir1A WEA'/ m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR m <br /> 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. TO <br /> ,�I N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p <br /> T a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 3 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> m <br /> NORTH(N). C 0L� <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 -o <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 P <br /> BUILDINGS,ROADS,LAKE, LOT LINES. qj <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GiRAPgD OR FILLED. ` ' <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDE OR, ET;jv <br /> E PLANS V 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. �� ( O M' F <br /> o �7•u <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE V I KATION M <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. AIG 6 ?0 0 <br /> CONDITIONS OF PER1 <br /> BORNE �2 <br /> / §a <br /> ' DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERM210�CO( /V <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. T <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. 5QJ6 <br /> G11 / V/- <br /> m � II=Ca m <br /> 6. m � 3 CL yam ;13 <br /> C: N O 3 <br /> 7. Z : y m a <br /> m <br /> - �: <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j c <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 any accompanying schedule)and I further declare that Ire cognize ` m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m C <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 to have access to the above described premises at any reasonable time for the purpose of inspection. CD <br /> r CD <br /> CD a <br /> SIGN HERE <br /> (signature of owner or bullag co a tor) / / (date) <br /> ZONING ADMINISTRATOR <br /> ). 1: <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />