Laserfiche WebLink
on GaYp, <br /> Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator ° a <br /> APPLICATION FOR LAND USE PERMITS 3 0 D3 <br /> w <br /> / I <br /> OWNER ��fA�LLcS ,4LLE/1/ TELEPHONE 6l �3��5�,•Z� m <br /> S O <br /> HOME ADDRESS <br /> 0 a <br /> 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME .. <br /> 1 <br /> LOT / CSM V 3 P <br /> LEGAL DESCRIPTION(see tax receipt) Ca 1 64 <br /> yr <br /> v�/ N � <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE�ADDITION n <br /> S.N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION Cn <br /> `i <br /> I X 4Cu <br /> Q ,— ' <br /> STRUCTURE/ADDITION USE: rT�v���/s���-/r<9pc --Q � <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR _n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. c j fi) <br /> DIRFCTIONS FOR PLOT PLAN m DRAWING: (AERIAL OR TOP VIEW) Oa v_ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m e_ <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y <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 /> 0 <br /> STREAM OR RIVER. <br /> 4. SHOW THE LOCATION OF THE WELL(",SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- <br /> INGS,ROADS, LAKE, LOT LINES. JZ <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS u <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE g <br /> ISSUED. <br /> Z O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <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 /> PONDS, RIVER UNLESS SPECIFICALLY PEWITTEV. <br /> 5. /Up �nl/ T Vlaces�1.✓ = m m m <br /> ,�r .� fa be rr'inal- tui-- �o �`� 1 2 3 a I �Q M <br /> 6. /VO r/CBS Or IXj,I �c S ' ° a R ,On `s U3 3 <br /> �, N O <br /> O : <br /> 7. =0 i m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my E 3 g '. ? ID <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> 47: O <br /> sue a permit. 1 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 w <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. - , <br /> o : <br /> SIGN HERE building ate) <br /> re of owner r contractor) <br /> ZONING ADMINISTRATORh h d 110 4S <br /> N NN N N 0 0 <br /> N Ln0PW 00 <br /> O 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />