Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> TjN K <br /> OWNERV U 1 TELEPHONE ]/5 ,3;Z <br /> n n r iedi�) O� <br /> HOME ADDRESS ,, 9�-3 L l SL �r �1_ ),q*,-- ei �+ CD <br /> rCD <br /> 0 <br /> EMERGENCY/FIRE NUMBER S��/y�� ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) � i L csh, v >�-� ) 37—/ m� � >r�� �� ice- � - <br /> DWELLING/BUILDING ElGARAGE/ACCESSORY STRUCTURE IN ADDITION ❑ PRIVY ❑ y 0 <br /> 0 <br /> TYPE OF PERMIT(S): v ' NN- <br /> FILLING/GRADING ❑ CAMPING U IT ❑ SUBDIVISION ❑ n <br /> {�64-e el--e n. a6 x �D H <br /> STRUCTURE/ADDITION USE: o <br /> r (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: t�Q 7`S CyA�,o�1UT✓ y E <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 9 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p = �fJ <br /> x m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. t7 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ;? <br /> NORTH(N). CO) -tz 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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. 9 <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 /> 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. 1 o <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <br /> NEEDED. y 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z l <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 <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 a <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> S TBACK AREA. / <br /> 5. //l.�f' �GuL�/' �Y -ft/`eY //1�S7c. �l0 S� <br /> ; vd 00 rn <br /> J <br /> 7. 0 : M �,G XI <br /> =� m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 10 j 6 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 <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 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 persop4c,have aqqess to the above described premises at any reasonable time for the purpose of inspection. T <br /> m : <br /> m <br /> 4 : <br /> SIGN HERE AL by 2_5;;% � <br /> (signatu e o owner r bull n contractor) (date) <br /> ZONING ADMINISTRATOR (A <br /> f» to to v+w v+ <br /> N N (!1 N N ut Vt <br /> Vt VtO Vt (Ji00 <br /> c o 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED o o <br /> 0000000 <br />