Laserfiche WebLink
al '' <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> ^- r <br /> o <br /> `_ y <br /> OWNER TELEPHONE ,( TZ7, 71,y& a^p� <br /> HOME ADDRESS �S/-3 A9t�1I A-y - ,�1,)14m NA)- S5 % ?JL/ v �j <br /> r m <br /> EMERGENCY/FIRE NUMBER ROAD NAME /ryfa rn'7 ( .. <br /> LEGAL DESCRIPTION(see tax receipt) I Kt V L 4 a(�—40—/[/ 1 <br /> DWELLING/BUILDING 1-1GARAGE/ACCESSORY STRUCTURCEI_❑ ADDITION X PRIVY ❑ rn <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ o' <br /> _ 5. <br /> STRUCTURE/ADDITION USE: SG,eFEn/ Pnecit oAJ /S T/Nle /Ox 1,;L T t` <br /> (Home/Cabin; Commercial Business; Bedroom;Deck; etc.) m <br /> BUILDING CONTRACTOR: �j )bud Like <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. T <br /> ° v <br /> y (� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T CL <br /> ?� Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. t7 m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ;? Q , <br /> NORTH(N). N <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. c <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. c 4p <br /> o <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. o I <br /> CONDITIONS OF PERMIT: C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. l <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALON ORELINE. ` �y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECI� Ihl_ rl�J <br /> PERMITTED. 1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITH! T ATER <br /> SETBACK AREA. <br /> 5. <br /> A - an d C7 0 -0 <br /> 6. n aj t h'Jl. m � � <br /> �7 > <br /> t✓R > v N <br /> .N ; <br /> I declare that this application (including any accompanying schedule) has been e d e and to est of my Cr ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am respons! tail Ecuracy of m E' C <br /> all information contained in this application(including any accompanying schedule)and I her c I I recognize m m . A <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to havjl access to the above described premises at any reasonable time for the purpose of inspection. T <br /> m : <br /> SIGN HERE 7—/V-"2 <br /> (si ture ner or build ntractor) (date) <br /> ZONING ADMINISTRATOR C <br /> wv+wfnfnfn� <br /> N N N N N N N <br /> V 7 V 7 O V 7 V• O O <br /> TOWNSHIP PERMITS MAV BE REQUIRED <br /> �C 000000 <br />