Laserfiche WebLink
Burnett Gounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -Co CD 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> UT O <br /> N <br /> C <br /> OWNER161 pm� TELEPHONE <br /> HOME ADDRESS1� <br /> ggsC O a RuSSi:t� �►� n�a, N Pk� mil ss��y <br /> r m <br /> 0 <br /> EMERGENCY/FIRE NUMBER NA ROAD NAME �Cb�Mc-R <br /> NVJ -1/S 30 O N 1"1 VviN� 1 <br /> LEGAL DESCRIPTION(see tax receipt) �3 PIAt�►TAt-lOIJ ^UNtnny`rowel (id m <br /> CD <br /> DWELLING/BUILDING ® GARAGE/ACCESSORY STRUCTURE 19 ADDITION ❑ PRIVY ❑ \ 0 <br /> o <br /> TYPE OF PERMIT(S): Q C � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION Eln <br /> � '^ , nge <br /> STRUCTURE/ADDITION USE: EtlME /PtR(�t� ""� ���t 0 <br /> (Home/Cabin; Commerci )�usiness;bedroom; Deck;etc.) W <br /> BUILDING CONTRACTOR: <br /> M ElJ.nf �t,t i 6+ <br /> U <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR m <br /> O <br /> � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. B <br /> A N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. -n 0 Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m m C` <br /> NORTH(N). C c�(� <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. \ r`� 0 <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 /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o , <br /> f <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT (� <br /> ISSUANCE. 1 I r <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 /> 5. SETBACK AREA. Ll <br /> m6. 0 = m r 0 � Q O M <br /> -O N CD X <br /> C y y O <br /> 7. Z : N N <br /> o : : � m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of my (} cj c <br /> PP C 9 Y ) Y �r <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 10 COD� m 17 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 administerinP"nty_ordinances or other o <br /> authorized person to have access to the above described premises at any reasonable time hp purp'oiq-ofi . <br /> M <br /> r <br /> TrE : <br /> SIGN HERE <br /> (signature of own wilding contractor OC ata' Jr'/t <br /> ZONING ADMINISTRATOR \ �t�� T G `Vv� <br /> BURNETT COUNTY <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING <br />