Laserfiche WebLink
Burnett *%unty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 'aci�. Z <br /> APPLICATION FOR LAND USE PERMITS 3 ° <br /> r <br /> N 0 <br /> N <br /> -I C <br /> OWNER in r ; N <br /> ie-r4 <br /> � f..� TELEPHONE 7��� <br /> `7 Ty �� <br /> HOME ADDRESS04Q e r o=- <br /> EMERGENCY/FIRE NUMBER ROAD NAME C4l1 i.W . <br /> LEGAL DESCRIPTION (see tax receipt) / � ` m <br /> N <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION�❑ ti <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ S. <br /> .r5. <br /> STRUCTURE/ADDITION USE: 4. �(p Y *-�4 I a' <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) rn <br /> m <br /> BUILDING CONTRACTOR: k?Q Q Ce 6u r S:P ) ✓C5 <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> A N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> T <br /> 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 fD <br /> NORTH(N). <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 <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 <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. c <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0f <br /> NEEDED. (WWWI <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 1 <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 /> SETB CK REA. <br /> 5. <br /> A C)r <br /> , m 10 L <br /> m �• m m <br /> 6. m � 3nm �Q .'0 <br /> m C w y 0 <br /> 7. o <br /> 07: <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ` a c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- y p <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 administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> CD <br /> SIGN HERE 1 P'C/L -�`��Dw� . <br /> (signs re o er or building con (date) <br /> ZONING ADM ISTRATOR L �_ <br /> N " M fel V <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 <br />