Laserfiche WebLink
IPA- c - <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 1 <br /> 3 <br /> �4-- �4 y <br /> �R2c � (33 0f 6F2 -Csar <br /> OWNER Co �/f TELEPI/H�O,(/NNE/h 0 <br /> HOME ADDRESS a 7�K Z C© ✓2?' V V`L I I LttL�� <br /> EMERGENCY/FIRE NUMBER o2 ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) p2 V l t ✓✓✓r 0 <br /> M. <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY ❑ ° �\ <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑n/ CAMPING UNITE]�JSUBDIVISION ❑ 5 <br /> STRUCTURE/ADDITION USE: oy <br /> (Home/Cabin; Commercial Busines , Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: MaGtJ/yJ �IZ�.�P� g' <br /> v <br /> m <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. <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O <br /> Z l <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m I <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). W c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m <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. Q> <br /> S. 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. o <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Cr <br /> NEEDED. rC�nn <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z V I <br /> CONDITIONS OF PERMIT: c I, <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 0 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. ��t -P� e 0 <br /> 1/ ,w{in' +''/\J(,IJ^,'I, C✓�/µl/,/�Id /� / � mr O <br /> Oo 'q0 <br /> 6. / ry - <br /> P 3 n m <br /> c�— Cu/O� Z N <br /> O <br /> O <br /> ur : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my r7 c ID <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 any accompanying schedule)and I further declare that I recognize m m <br /> M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- oO O <br /> sue a permit. I further accept a1glability which may be a result of the County of Burnett relying on this information I am m <br /> providing in this application. Agree o it county officials charged with administering county ordinances or other m <br /> authorized person to h e e to a ab a described premises at any reasonable time for the purpose of inspection. m <br /> m : <br /> M <br /> SIGN HERE (� <br /> ( ig�I of owner r building contractor) (date) (X�3 <br /> ZONING ADMINISTRATOR / )!Y) I r : <br /> Fn44<nFnvtnr <br /> N OiNNUt <br /> VtOut utOO <br /> 0 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 0000000 <br />