Laserfiche WebLink
rn1. C,L7'n�' <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v ci Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> OWNER e�0..V\ -�— TELEPHONE <br /> �ovv�e.•. (�a.S Scl�irgeu.F- IS . v <br /> HOME ADDRESS 0 <br /> 0 <br /> EMERGENCY/FIRE NUMBER k�_ , ROAD NAME <br /> ( <br /> LEGAL DESCRIPTION(see tax receipt) <br /> n <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY 1:1m0 <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING E] CAMPING UNIIIT ❑ SUBDIVISION ❑ % <br /> STRUCTURE/ADDITION USE: QL7l[Y t�+ 'S� Q�(�S,T,�(/�A (v A�1�V� N �J <br /> o <br /> (Home/Cabin; Commercial Busines ; Bedroom;Deck;etc.) Cr) <br /> 0 <br /> BUILDING CONTRACTOR: <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) guiauh ell O C <br /> I � �t enc 2 „ o <br /> o�p�p \ f1 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHO 00&kA'V N TO SCALE � Z ) m d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m n <br /> NORTH(N). o <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 Z <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 C> <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. m <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN B W <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT «c <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. tk7 <br /> 6. � 3 CL M <br /> M C 1 0 <br /> 7. o: y < <br /> —w m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to thebest of my c p <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ((�� <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize Fin� <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m o <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 m' <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> m : <br /> m <br /> SIGN HERE <br /> (signat reQf owner or buildin tractor) —� (date) <br /> ZONING ADMI OR �v 2 <br /> Fnu�wfnfnv+� <br /> �N NON (N7100 <br /> TOWNSHIP PERMITS MAY BE REQUIRED0 0 0 0 0 0 0 <br /> 0000000 <br />