Laserfiche WebLink
6/1 uW6P <br /> Burnett r nmty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> o <br /> OWNER T3/�fj,� ZT—C) So TELEPHONE ��.���. � o bi <br /> m <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER f�Q� ROAD NAME �/► + �u/��/ e(J o <br /> LEGAL DESCRIPTION (see tax receipt) 7—VQ AJ y� r�t� �� LQ 717* N }(� <br /> 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE <br /> ADDITION— <br /> SANITARY- <br /> DDITION SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 CS�— <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> C <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR m <br /> /// m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. Ay �g�J" 0 <br /> (J,� �y a y <br /> DIRECl40NS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) (f�/1fj S�� O v <br /> /oa jft TZ <br /> 1. -ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ;° <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, <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 t <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q <br /> ISSUED. 0 <br /> r. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> 1 <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 PERJAITTED. <br /> V : CD C vi y o J �_ <br /> J <br /> : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my a G� p <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of m c <br /> CL <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize CD m O <br /> m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is v� <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 ch i i nn county ordinances or other m <br /> authorized person to have access to the above described premis t e rmwpurpose of inspection. T <br /> m : <br /> m : <br /> SIGN HERE '77 — O <br /> (signature ow er or building contra ) (date) <br /> ZONING ADMINISTRATOR <br /> BURNETYCOUNTY 5A . <br /> N <br /> T NSHIP PERMITS MAY BE REgOMG o 0 0 <br />