Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator _ o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N <br /> H <br /> C <br /> a <br /> OWMER �\ ( ),C— (�j ,I�f 4�'t � TELEPHONE N Ob <br /> MAILING ADDRESS <br /> � m <br /> PROPERTYADDRESS S�M �_ W <br /> LEGAL DESCRIPTION(see tax receipt) & / C_/ CS to V3 Ploy p(—3 9-1,y <br /> M <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION Q Cl) <br /> TYPE OF PERMIT(S): n , <br /> FILLING/GRADING ❑ CAMPING UNITyr a <br /> ❑ SUBDIVISION ❑ / <br /> /�, A �� - .� y <br /> STRUCTURE/ADDITIONUSE: Pow d- (..)1�-IGL�C —Y� (/P� 0 <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) ( 0 <br /> m <br /> BUILDING CONTRACTOR: <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> In <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O - C <br /> rn <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o o <br /> 'TI <br /> T 1 00 Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. ng 0 C <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m <br /> NORTH(N). <br /> n <br /> CD 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 to l <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. p o <br /> 4tp <br /> .SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 1 O <br /> BUILDINGS, ROADS, LAKE, LOT LINES. ( `e C1i <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 I =0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. �I o <br /> 4-14 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VY f [ gN o J a c <br /> NEEDED. w��JJ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> 1� 2Q02 ! o ' <br /> CONDITIONS OF PERMIT: MAY 13 L) O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS `1 <br /> ISSUANCE. COUNTY 6� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHOR NI W <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. (ry <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. d <br /> 6. <br /> $ 3 a m a m <br /> v Rcy � o � 3 <br /> 7. z @ m ° i 522 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon b the County of Burnett Wisconsin in determining whether to is- `� <br /> P 9 P Y tY 9 VE E � <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information <br /> [am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to hilye qpeess to the above described premises at any reasonable time for the purpose of Inspection. m o <br /> SIGN HERE <br /> (signature of ne or�uilding contra r � (date) <br /> tl. <br /> ) <br /> ZONING ADMINISTRATOR <br /> N CST 169 <br /> ` <br /> Ut O U O <br /> TOWNSHIP PERMITS MAY BE REQUIRED �jl�� t 051 <br />