Laserfiche WebLink
carr �� <br /> Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator Z <br /> APPLICATION FOR LAND USE PERMITS 3 4 pr� <br /> ^" 0 ]U <br /> 1_ <br /> KtA _ it, <br /> I/ / w = Q <br /> OWNER V� h r (�N Ota l� Q O i n Yl TELEPHONE 0 <br /> p 30 17 a IUA <br /> HOME ADDRESS V t Sctg72 O <br /> EMERGENCY/FIRE NUMBER 21 28-j ROAD NAME <br /> oz � ioo 01 Zoe p� Say 7"yoni � <br /> LEGAL DESCRIPTION(see tax receipt) � 5 q ��l) I6c K Cc7/�(l 5 5J� 1 �^�� `�rERY <br /> �- <br /> U o'L(t4 J Wf y <br /> TYPE OF PERMIT(S):DWELLINGIBUILDINGGARAGE/ACCESSORY STRUCTURE ADDITION P <br /> C <br /> 4- <br /> SANITARY PRIVY SUBDIVISION FILLING/GRADING CAMPING UNIT IT <br /> �— <br /> SUBDIVISION- <br /> .0) <br /> STRUCTURE/ADDITION USE: o h%4 � <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) ^ -I <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In 1 - <br /> DIRECTIONS FOR PLOT PLAN DAWING- (AERIAL OR TOP VIEW) <br /> -n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 C r <br /> NORTH(N). <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(OH OF LAKE, 1 <br /> STREAM OR RIVER. �( o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- <br /> INGS,ROADS,LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 1 � <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 0 <br /> ISSUED. g ° I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z .. <br /> CONDITIONS OF PERMIT: o � <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 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, <br /> 5. la3POND. <br /> DS, DIVER UN SSS ECIFICALLY P RMITTE6. 'J- <br /> 1�� f rte - , <br /> / CK <br /> fA <br /> 7. wow �m � <br /> o € w �� <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my g i E m <br /> m <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of i <br /> all information contained in this application(including any accompanying schedule)ark!I further declare that I recognize mm ? m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other °O <br /> authorized person to have access to the above described p <br /> Zpunlses at any reasonable time for the p rpose of inspection. ' <br /> - : <br /> m : <br /> SIGN HERE <br /> Ignature of owner or building contractor) (date)I <br /> ZONING ADMINISTRATOR <br /> e w w w w www+ <br /> N NN N Ntn ON <br /> N P P P P O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0$g o g <br /> !.SOC <br />