Laserfiche WebLink
6 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ci Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> UT o <br /> N <br /> C <br /> n <br /> OWNER i R�lGlG n <br /> l/IGCI JDIUSD�I/ TELEPHONE (05%-730-C1y5'� o <br /> HOME ADDRESS 93 / GO.eILGT !uD®L?F�U.L'S/ <br /> �I �Si2 <br /> r m <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAMECn <br /> GJ C <br /> p <br /> LEGAL DESCRIPTION(see tax receipt) 020 _932,5__ 0/ 1660 <br /> A <br /> DWELLING/BUILDING V GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ (n 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ ` ! a <br /> STRUCTURE/ADDITION USE: C46/AI Z R!2 W/JrH' 49e4e ' 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) N t = <br /> BUILDING CONTRACTOR: W06D6ZIAIO A IJr&/I`S P0 &X &Q0 &I IV6 AV <br /> 50 <br /> CDrD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n y .� <br /> ;aG C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <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 m <br /> NORTH(N). y 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 \ v <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 i <br /> BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IN <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. I 0 <br /> = I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN T 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z (1 . <br /> CONDITIONS OF PERMIT: o xJ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT (� C <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 <br /> PERMITTED. <br /> 4. NO STRUCTURE§, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER n <br /> SET AREAeZC1/� <br /> 5. m � miu rDMnF m <br /> 7. V O 'j1 <br /> _ cn : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of a T <br /> all information contained in this application(including an acc <br /> pp (' g y panying schedule)and I further declare that I recognize m m 0 <br /> that this information I am providing will be relied upon by the Burnett Wisconsin in determining whether to is- Gj <br /> sue a permit. I further accept all liability which may be a res umatt relying on this information I am <br /> providing in this application. I agree to permit county off <br /> t county ordinances or other <br /> authorized person to ve access to the above described pr es ata a urpose of inspection. -n <br /> m <br /> CD <br /> // <br /> SIGN HERE / C"4 <br /> (signat re own o i ontraytpr) 00f (d te) <br /> ZONING ADMINISTRATOR tf E / <br /> ONS N7y <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />