Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m c o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> I r <br /> i O <br /> N <br /> C <br /> OWNER �^ 1 B. <br /> �{Hht'TI�N'� � 1/� TELEPHONE '�/S-y��-c�-�.l 'off 0 <br /> m <br /> HOME ADDRESS uolc <br /> �^ <br /> r <br /> 0 <br /> EMERGENCY/FIRE NUMBER �� y -� ROAD NAME L;'-M 1C R AIS �� ~ <br /> ( <br /> C-Nm <br /> LEGAL DESCRIPTION(see tax receipt) QC` (x t (,o}3 / V_ �J iP I ��� fa a V-4 y <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ® PRIVY ❑ LoT 1 c <br /> TYPE OF PERMIT(S): o- <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �0/ o, <br /> STRUCTURE/ADDITION USE: �7)yX � GLGGLO7(� �� 5.o <br /> (Home/Cabin; Commercial Business; Bedro m; Deck;6[c.) m �, <br /> m <br /> BUILDING CONTRACTOR: 0"c C°k-�:Tryry- `v"4 T. <br /> v <br /> 0 <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 c <br /> � J <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O cB <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE c n� <br /> NORTH(N). to 3 <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. Q' 1' <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N W <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. m' o <br /> O � 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN q <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <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. p) <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �/ Q <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> Xvtom <br /> 0 n <br /> � 3 'kaz <br /> 6. o' = 3 <br /> R; C N N O � <br /> Z : oo . _' � <br /> 7. �Q <br /> _ m. : in <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I 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 CL <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- d 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 m' <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. m <br /> SIGN HERE .� � ( W�+— �c� - fa— ! v+ . <br /> (si at re of ow r r building contractor) (date) <br /> ZONING ADMINISTRATOR . . . . . ' ` d+ <br /> ,fid fA <br /> to to M M En <br /> N N OI N N OI ut <br /> qOq y 0 NOpl ut OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED � c� c o o O o 0 <br /> SG/_ t✓' w �U 0000000 <br />