Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator M o° o <br /> APPLICATION FOR LAND USE PERMITS 3r <br /> VT a <br /> OWNER -Jbhn4I I' `, -P TELEPHONE <br /> v GJ a <br /> m <br /> 15 m Oiam®r�d hJau Armee i/a Ili i,m�55 <br /> MAILING ADDRESS 0 <br /> PROPERTYADDRESS 3'llC) (rjkU,e(:S W o <br /> LEGAL DESCRIPTION(see tax receipt) C NN � <br /> (7` 2 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION �/ \fp 0 <br /> TYPE OF PERMIT(S): `Q <br /> FILLING/GRAD NG n❑n CAMPING UNIT ❑ SUBDIVISION ❑ c, <br /> STRUCTURE/ADDITION USE Com` Q� f=7 Y IK.� I � o <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) to <br /> BUILDING CONTRACTOR: iu <br /> v <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. O O <br /> ZIy <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O c <br /> T r z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m TA <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m :1p <br /> NORTH(N). q o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO mB <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. IN Y� <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS 0 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o (} / <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z O <br /> CONDITIONS OF PERMIT: P I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT r <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. A O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER (� <br /> SETBACK AREA. <br /> 5. <br /> 6. � <br /> n > > n n 2 <br /> 6 FO. �p F _ 3 <br /> a C N y O J <br /> Z C N N O i t0 <br /> �. p RO N T� m <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m = : �I O <br /> PP f 9 Y ) Y Y ' �, : v , c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of@ n <br /> all information contained in this application(Including any accompanying schedule)and I further declare that I recognize m ` In <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- vi <br /> sue a permit. I further accept all liability wh%h may be a result of the County of Burnett relying on this Information I am m o <br /> providing in this application. I agree to it my offi ' ged with administering county ordinances or other ,o <br /> authorized person to have access to scr' r . es at any reasonable time for the purpose of jinspection. <br /> T <br /> � a <br /> SIGN HERE c ) <br /> (s/ipina('urne owner or building contractor) (date) 0 i <br /> ZONING ADMINISTRATOR l-- I f/L Pl �D �DI/I E E E E <br /> TOWNSHIP PERMITS MAY BE REQUIRED a o o X o <br /> TIS PERMIT SHALL EXPIRE ONE YEA - . <br /> DA FIS ANCE 93 <br /> R 1m i4- d- /Q 4-tr T-)late'7�p '-71 - �'o l�s�rwho -N 9-ag�5 <br />