Laserfiche WebLink
a � <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. n <br /> 0 �V <br /> y O <br /> OWNER Kenne_�. I'Y�. nn f�. �� IQ 1�h TELEPHONE ', �3 _'� SD-- 139$ v t\ <br /> m <br /> HOME ADDRESS <br /> 1 Da-So 1m1'1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME } )�r <br /> 10'I c N E y &Jr 4-kt N t IN Sw //A/, Se.c44 on of 9, � <br /> LEGAL DESCRIPTION (see tax receipt m <br /> c <br /> DWELLING/BUILDING 9 GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ N ° <br /> TYPE OF PERMIT(S): Q ' <br /> FILLING/GRADING ❑ CAMPING/UNIT ❑! SUBDIVISION <br /> ! ❑ 5 <br /> STRUCTURE/ADDITION USE: �1'0 10 �{�� 7 O /• �Q �� ✓i'a G 9 Qf4te ['y ,+I 0 <br /> �(Hofme/Cabin; Commercial Business; dro ; Deck;etc.) J to <br /> 2. <br /> BUILDING CONTRACTOR: L\SDI ,Up-(S <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR T � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. Q <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) _0n o <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 IM n <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. ) 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. 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 /> v 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN °, <br /> NEEDED. czr <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 0 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 'O <br /> ISSUANCE. 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. — <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 /> � vn? CD <br /> o� <br /> 6. m� 3amxe <br /> N C y 0 ° <br /> N H O <br /> 7. <br /> O <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizeCD <br /> M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m <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 m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. CD <br /> m <br /> m : <br /> > - 9 <br /> SIGN HERE/� <br /> (signatur caner oruild�tr t r)) / (date) <br /> ZONING ADMINISTRATOR <br /> vi <br /> NLn v+to to <br /> LVP <br /> N)Nio � N) O <br /> TOWNSHIP PERMITS MAY NR QuA�2000 <br /> -Irf ! 00000 0 <br /> n�,Cir, <br />