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 /> r <br /> u?, CD <br /> OWNER ►ym��V r., TELEPHONE 4•z5-SSO�_ ^p Q <br /> MAILING ADDRESS <br /> q)' 53 YATE5 bA r Qo v ri yn PAr k M 5W 3 7-04 f <br /> M <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION(see tax receipt) G�-L f L 7 OShn v ' D m <br /> DWELLING/BUILDING % GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ rn o <br /> TYPE OF PERMIT(S): FILLING/GRADING ❑ CAMPING UNIT 1:1 SUBDIVISION ❑ Fvt , e <br /> ^STRUCTURE/ADDITION USE: CAbW /A0M(E 33 L - ouJ 4a )UD `va <br /> ° <br /> (Home/Cabin, Commercial Business;B droom; Deck;etc.) rn �J <br /> m <br /> BUILDING CONTRACTOR: m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> M <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 <br /> NORTH(N). <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. 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. ( 0 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 11, N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 1^ <br /> MUST BE SIGNED AND DATED BY THE OWNER. Q o <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z C? <br /> CONDITIONS OF PERMIT: P ( r <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. L`l <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. Tom. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER V <br /> SETBACK AREA. <br /> 5. 1 a Pri <br /> egle5 O r <br /> s1 �1 ajlecp S'ie�rre 7� �� inJl4 re, V` <br /> m D am xa� <br /> ryfro <br /> - 53 CH 0 0 3 <br /> 7. Ccs r/ 'o of �uf'�U�fh s,fe, �- M <br /> - m <br /> I declare that this application (including any accompanying sched ) has been examined by me and to the best of my r ,I Q c C <br /> �N <br /> knowledge and belief it is true,correct and complete. I acknowledgg that I am responsible for the detail and accuracy of [� m n iA <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize -V m CC o m <br /> that this information I am providing will be relied upon b the County of Burnett Wisconsin in determining whether to is- <br /> sue <br /> p Y tY 9 <br /> sue a permit. I further accept all liability which may be a result of the-Cou ty of Burnett relying on this information I am d ; <br /> providing in this application. 1 agree to permit county officials c i Bring county ordinances or other o <br /> authorized pe to have access to the above described premiss r s rpose of inspection. m <br /> CD o <br /> / m m : <br /> SIGN HERE a <br /> S <br /> ig ature of owner o ding contr ) (date) <br /> : <br /> ZONING ADMINISTRATOR <br /> CO IT (A(A(A(A N <br /> 77 N T N N O O <br /> K��D <br /> TORM <br /> WNSHIP WITS MAY BE Q/ (`' <br />