Laserfiche WebLink
l <br /> Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator -V a <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> 0 <br /> 4 N <br /> OWNER � m A /� �Zj/� �r l OTELEPHONEif <br /> z- y3a-7o3 <br /> HOME ADDRESS / C4 - f oV <br /> O <br /> 09 <br /> EMERGENCY/FIRE NUMBER 3� ROAD NAME r7 �S e <br /> Z. $'oC. 2-Z — <br /> LEGAL DESCRIPTION(see tax in receipt) <br /> Pfd o�F` G��. � Lo�F 1 450—,e- TVftQiS'cc) 1. � <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION Q <br /> n <br /> 5. <br /> a <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION (� ) <br /> 0 C-) 7 <br /> STRUCTURE/ADDITION USE: _4CTYyy�_ fii cr� <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. 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) _n <br /> ^ Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). <br /> n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. 9 <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. 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. �' c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BECr <br /> 0, <br /> ISSUED. .. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q <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 S> <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> ;a -0nrm oom <br /> o � .m <br /> t C ow 5, 3 <br /> 7. Z : <br /> -_rn m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Z$C) C <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m g E <br /> CL L . <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize e m : 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 I am m <br /> providing in this application. I agree to permit county officials charged with adminisfazinasounity ordinances or other m E <br /> authorized person to hav access to the above described premises at any reasonable ti o -n <br /> fo <br /> C5 : <br /> w i i <br /> SIGN HERE A <br /> ( <br /> na�ni of o building contractor) „,� a )��7 <br /> i %JU <br /> ZONING ADMINISTRATOR <br /> wwwwfnw01 <br /> It. N N O 01 <br /> P PtN N Ili <br /> I7U� O 71 UI O <br /> TOWNSHIP PERMITS MAY BE REQUIRE <br /> CtDC sen? 628-C17 <br />