Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v G) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N <br /> OWNER 'V' �re RS TELEPHONE cI dal- 9 3Q- 7g7p a <br /> I m <br /> HOME ADDRESS '7:5,9 0 ��O��.r✓ '714, �,'h�W hASS6n/ MPJ 55317 v <br /> 3�9Z 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME R r'Ch .f_ RQ <br /> Q, � <br /> LEGAL DESCRIPTION(see tax receipt) 1— 0 f V C S fy% V. S 12 ( 0 6 o V 1045 1e+2. <br /> m > <br /> n <br /> DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ Cl) <br /> TYPE OF PERMIT(S): � <br /> r <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ o: <br /> STRUCTURE/ADDITION USE: �46rr E — C A b%^l o. <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) co <br /> BUILDING CONTRACTOR: A Nd- —so r-3 C O tj S+or L."C—+to 0 <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. _t 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> w <br /> C <br /> O cxIII 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. a v Z <br /> In <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C m O <br /> NORTH(N). 1nI ' <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m V 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. (,� 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 ) 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> 0 � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 I <br /> NEEDED. a ° <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND <br /> 3. NO GRADING OR SHO ELAND ALTERATIONS ARE ALSHORELINE.IS RESTRICTED ALONG <br /> LOWED UNLESS SPECIFICALLY <br /> CAL <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK{AREA. <br /> 5. z v o rg�i v v v <br /> 6. )O � 3a �b ��� � <br /> 7. Z HmR .1=i <br /> o <br /> I declare that this application (including any accompco <br /> anyin schedule) has been examined by me and to the best of my A <br /> : pp <br /> knowledge and belief it is true,correct and complete. I ac ne that I am responsible for the detail and accuracy of i m K C <br /> all information contained in this application(including any schedule)and I further declare that I recognize C m m <br /> that this information I am providing will be relied upon b Wisconsin in determining whether to is- G) p <br /> sue a permit. I further accept all liability which may be relying on this information I am <br /> providing pp y P m <br /> p gin this application. I agree to permit county Isis charge d s unty ordinances or other <br /> authorized person to have access to the above descri emises at any reas n e t e purpose of inspection. <br /> T : <br /> ID <br /> Coo <br /> SIGN HERE <br /> ( ' ature of ow or,building contra (date) ;`�+• <br /> A <br /> ZONING ADMINISTRATOR <br /> CA <br /> t»v+u+w cn CA <br /> N Nc) NN P <br /> 57 Vt O 97 P . O <br /> TOWN IP PERMITS MAY BE REQUIRED <br /> 1c) 0 0 0 0 0 <br />