Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Offices �MF'UTEnR%SC or CD 0 0 <br /> APPLICATION FOR LAND USE PERMIT �v►t' Ed <br /> CD <br /> OWNER L 0�1 G L,(S/�o�I�6 C(J TELEPHONE f 6-'j b—17 <br /> m <br /> MAILING ADDRESS /s'O e/ flu , <br /> , �— { (it1 e b�S�e� w s`�� 3 <br /> r � <br /> -{ p 0 <br /> PROPERTY ADDRESS <br /> �. <br /> LEGAL DESCRIPTION(see tax receipt) C'ov LE , (OT3 a3--Lk)--I ` m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ cn 0 <br /> TYPE OF PERMIT(S): a 0 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �: <br /> / N <br /> STRUCTURE/ADDITION USE: �p (� r3 �, P- AJ 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <n <br /> m <br /> 0 <br /> BUILDING CONTRACTOR: iu <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> m 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 <br /> NORTH(N). o <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. d 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. t W <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I 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. , (0 0 <br /> � 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN g <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z ) <br /> CONDITIONS OF PERMIT: i I <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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY OQ <br /> PERMITTED. O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> CD ooQ) W 0 ODQo -0 <br /> 0 7 7 Cf n 2. (D m <br /> 6. CD Xc0 a m � .-. `D E <br /> a o m C y o <br /> Z C in o co -i <br /> 7. 0 m -n < : x <br /> — �, m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m v>: D <br /> pp ( 9 Y ) Y Y �c � : C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of 0 Cn <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m : rn <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- CD W: <br /> a 0 <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett r lyp�.nn.this information I am a) 0 <br /> providing in this application. I agree to permit county officials chargpgl I- �Jhi�ffl tefi tatty or finances or otherauthorized pe son to have access to the above desc ibed premises t` le i p th r o of inspection. CD a <br /> m <br /> - m a <br /> SIGN HERE i D a <br /> (signature of owner or building contractor) 2 !� elate) j <br /> ZONING ADMINISTRATORwlaq <br /> 24— T _ l <br /> 3URNET I g COUNTY !2 fA 69 fA ffl!N <br /> N' G J a' C) N Vl W W N O <br /> TOWNSHIP PERMITS MAY BE REQUlrZQ <br /> o cn CD cn cn N CD <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />