Laserfiche WebLink
6XVI <br /> M G) Z <br /> BurnetcCounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator N < o <br /> APPLICATION FOR LAND USE PERMITS N r- <br /> l TELEPHONE/�'�/2 <br /> OWNER <br /> � � <br /> HOME ADDRESS / G' 0 _ /�v ,/ �i2 C Z �7/� — YJ� /n <br /> EMERGENCY/FIRE NUMBER ROAD NAME R oh P/'�O <br /> U <br /> LEGAL DESCRIPTION(see tax receipt) <br /> c <br /> y o <br /> DWELLING/BUILDING ® GARAGE/ACCESSORY STRUCTURE LJADDITION ❑ PRIVYC = <br /> Cr <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ y' <br /> STRUCTURE/ADDITION USE: rn <br /> (Home/Cabin; Commercial Business, Bedroom, Deck,etc.) W <br /> fir <br /> BUILDING CONTRACTOR: <br /> m '\ <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR "n 3. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. Ja N <br /> O m <br /> DIRECTIONS FOR PLOT PLAN DRAWIN(2: (AERIAL OR TOP VIEW) -n cLO <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 C O <br /> ca <br /> NORTH(N). m a J <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF 1 c <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> D ALL DISTANCES TO <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AN <br /> BUILDINGS,ROADS,LAKE,LOT LINES. J <br /> 6. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. c <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS �(\D <br /> ) 2. c + <br /> MUST BE SIGNED AND DATED BY THE OWNER. p <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. <br /> 0 4 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. � � <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. ON IS <br /> 2. REMOVAL 3. NO GRADING OR SHIORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY LINE. h <br /> PERMITTED <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. y m an d D C m <br /> lbcLcles <br /> -6- 0 � 3 <br /> N O O <br /> 6. <br /> U)i m <br /> 7. - 21 IS <br /> declare that this application (including any accompanying schedule) has been examined by me and to the best of my G7 <br /> for the detail and accuracy of <br /> wledge and belief it is true, correct and complete. I acknowledge that I am responsible <br /> ,rmation contained in this application(including any accompanying schedule)and I further declare that I recognize m M <br /> 'reformation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> �. I further accept all liability which may be a result of the County of Burnett relying on this information I am <br /> ,,Is application. I agree to permit county officials charged with administering county ordinances or other <br /> n to have access to the above described premi at any reasonable time for the purpose of inspection. m , <br /> 40 <br /> (date) <br /> (signa of o er or buildin contrac r) <br /> �40� ) " <br /> N NOi N f110 <br /> VI V1 O VI 01 O O <br /> 0000000 <br /> 0000000 <br /> TO SHIP PERMITS MAY BE REQUIRED <br />