Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 'o0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N O <br /> N <br /> OWNER \ ��� TELEPHONE <br /> HOME ADDRESS / /�g l�/J�✓)PJ V� ` K� I JIIJ U1M W+ `jZ/O '^ <br /> v > _ <br /> r � <br /> 0 <br /> EMERGENCY/FIRE NUMBERROAD NAME <br /> ��/45� 535 �fJ R lCo1R/ Acrc.� 5,0/0 <br /> LEGAL DESCRIPTION(see tax receipt) <br /> 05--D /o DoT 4f--5lt4 V/meq CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ / rn 0 <br /> TYPE OF PERMIT(S): AI / s Q <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �" <br /> STRUCTURE/ADCara <br /> STRUCTURE/ADDITION USE: ° (n ^ <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <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. m <br /> O <br /> M NN'' <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. (� <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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. 11 f t <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATI� 3E DONE WHEN o �\ <br /> NEEDED. / 1II <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: <br /> �c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF 2MMIIIT',. ;J/1nt <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHOOREEL N�7-r� ( <br /> 3. NO GRADING OR <br /> ELAND <br /> WED UNLESS <br /> 4. NO <br /> PERMITTED. <br /> SS NOCRUDING RETAINING WALONS KS, ETC.,ALLOWED WITHIN THIE REQUIREDCALLY OWA'TErt <br /> SETBACK AREA. <br /> 5. <br /> X M. u0id0ma � m <br /> 6. ` 3mCOW o53 <br /> y N O O 0 <br /> 7. o : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my (� ' G) C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of ;a <br /> all information contained in this application(including an accompanyingschedule)and I further declare that I recognize PP ( 9 Y 9 fD m <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 <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. T m <br /> m : <br /> SIGN HERE <br /> nature of ner or i in r ( te) <br /> ZONING ADMINISTRATOR ox I' <br /> V IV <br /> TOWNSHI PERMITS MAY BE REQUIRED <br /> f <br />