Laserfiche WebLink
en c"np <br /> Burnet, 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 /> � � ` v TELEPHONE 6J � <br /> OWNER D � ' b <br /> HOME ADDRESS i15 -7 SCA MrY) �� Q U v O <br /> 7 Q /A�,/pp <br /> EMERGENCY/FIRE NUMBER !� 1 ROAD NAME /Ve-ISP IP I <br /> LEGAL DESCRIPTION see tax recei t <br /> TYPE OF PERMIT(S): <br /> DWELLING/BUILDING JZ GARAGE/ACCESSORY STRUCTURE 1:1ADDITION 11PRIVY ❑ <br /> p�'�7 <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUQDIVISI N ❑ v ` <br /> hh y�® N <br /> STRUCTURE/ADDITION USE: 1'e iowh f l� D/'IZ/ ° W <br /> (Home/Ca in; Comme al Business; Bedroom; De etc.) m L <br /> BUILDING CONTRACTOR: ri ` ' r 6Ia 7�,3— 7 5 <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INC P+LT�E OR 3ILLEGIBLE PLOT PLANS WILL BE RETURNED. 1 t�r l� Qj �DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) l/ ,U o��I't n m <br /> 010?- „ <br /> U T O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m \ <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y o 1 <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 <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Cr <br /> NEEDED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: ¢ Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 0 <br /> ISSUANCE. O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY I w <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK REA.. )� O� vP' I <br /> 5. A/ 91—'1 // O1- Grou�tr Ic1it�1�1 �jU C <br /> s.� <br /> ;02,IS L G w iwf S/�eca aB Yo M CD W <br /> 3 n o q <br /> 7. / }( J1 1• 7` be II(/3 r11 6 LQ - Z N � 79 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to thg best of my (j C <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of pa WcL B <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizei 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- 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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the aboNA Opscribe remises at ahy aso le r,the purpose of inspection. m ': <br /> mE <br /> SIGN HERE I AA <br /> gnatu of owner o ui ng contractor) 9 (date) <br /> ZONING ADMINISTRATOR <br /> 3 COUNTY <br /> °N1 N O (N71 N 0 0 <br /> TOWNSHIP PERMITS MAY BE REC tNG 0 0 0 0 0 0 0 <br /> 0000000 <br />