Laserfiche WebLink
do <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator -� o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> VT o <br /> N <br /> C <br /> OWNER pTELEPHONE 3Q0 301 3 46>9CD <br /> e <br /> HOME ADDRESS d $ 3 O ue ��— �'tQV�y�^1 '(J4 1 ' 1 Y� �61J olJ <br /> -1 t <br /> CD <br /> CD <br /> EMERGENCY/FIRE NUMBER 3 / 6 ) ROAD NAME ` OO A) LK RD 0 <br /> LEGAL DESCRIPTION (see tax receipt) Lot I C R ✓ ©, l� q6 �S 1 <br /> I I m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION X PRIVY \11� <br /> 7 <br /> TYPE OF PERMIT(S): ' <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ ` 1 n. <br /> STRUCTURE/ADDITION USE: CG VI h �'iS�fhent 4gotc� r7 /Oh 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) Cn � <br /> BUILDING CONTRACTOR: C6n PfbP,+ Qo <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR CD3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p m <br /> n n <br /> T Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 0 v � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). a <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. ) 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. 4 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. CX1 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. 2. <br /> 0 <br /> O 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 0 <br /> NEEDED. n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. ^ <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQU-1 F -W—�ER 4r�1 <br /> SETBACK AREA. il lJ <br /> 5. <br /> m <br /> � ' 'a <br /> Of cL m <br /> 6. / 'fes ,��_''i / �< a CD m <br /> 7. f N N O _ t0 <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by <br /> O,Arhe best of C) - C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for 1 rac of B 0 <br /> all information contained in this application(including any accompanying schedule)and I furtherVE at c gnize mCDM <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> C) : <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. 1D <br /> m <br /> CD <br /> SIGN HERE lo <br /> ( na re of own "ding contractor) ( te) <br /> Q <br /> ZONING ADMINISTRATOR <br /> q 6 <br /> TOWNSHIP PERMITS MAY BE REQUIRED lT <br />