Laserfiche WebLink
BUt'hett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> 0 <br /> M 0 <br /> N <br /> OWNER C//� F �� /�u` �/�'� TELEPHONE -715JV— '1,Q3 o <br /> HOME ADDRESS JD <br /> e) ��� �e�/G ULT— JY de <br /> 1-1 CD <br /> `In <br /> EMERGENCY/FIRE NUMBER ROAD NAMEt v '1 <br /> LEGAL DESCRIPTION (see tax receipt) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ , m <br /> TYPE OF PERMIT(S): I]y_�/ c <br /> FILLING/GRADING El CAMPING UNIT L[Y SUBDIVISION El a <br /> y /b <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin;Commercial Business; Bedroom;Deck• etc.) m <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0O = <br /> ja <br /> N 1 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) Oo J <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C) m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE ° Oti <br /> NORTH(N). a 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. P <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. fV <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. m o <br /> o 6 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c Q <br /> CONDITIONS OF PERMIT: <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. I <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 /> SETBACK AREA. <br /> 5. <br /> 0 0 CD m <br /> m �. ' �ma m <br /> 6. a mCrNi, -o5' 3 <br /> M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my tj c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- C!C... m 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 7r4,, m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to ave access to the above described premises at any reasonable time for the p rpose inspection. m <br /> SIGN HERE <br /> (signs e,)f owner or builds g e tractor) (date) <br /> ZONING ADMINISTRATOR / w <br /> 4a 40 4� <br /> N N O N N O M <br /> (J (lO V1 U1 O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o o g C>0 0 <br />