Laserfiche WebLink
CtyBurnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -o Z <br /> APPLICATION FOR LAND USE PERMITS < <br /> 0 <br /> y O <br /> ,� C <br /> OWNER M A�-;e_k LTELEPHONE <br /> 61z-gqo--73` 3 a C�o <br /> HOME ADDRESS I �j o (j SA-Ljo ) 0S&rasy i j j-e m 0 <br /> CD <br /> q �0 <br /> EMERGENCY/FIRE NUMBER / �C f�z ROAD NAMECASfi Lr,�,�L (7 <br /> LEGAL DESCRIPTION(see tax receipt) 9 `� r� _ V <br /> D S CD <br /> n <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION_ <br /> C <br /> Q <br /> CL <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> STRUCTURE/ADDITION USE:_ 0 Pk6l �3 (✓tJ <br /> J l7 <br /> (Home/Cabin; Commercial usiness; Bedroom; Deck; etc.) D <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 G <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m T <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p m <br /> n m <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS (NB)AND INDICATE m m "a A <br /> NORTH(N). C O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO Cl) v <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <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. Q <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N np <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS 0 l <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE o0 ( i <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. p wl O <br /> CONDITIONS OF PERMIT: Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT (V <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 PERMITTED. <br /> 5. <br /> M -0 <br /> 6 � 0r,- > 0a0 -0 <br /> . D � amxo�' 3 <br /> _ mCN �' <br /> 7. N J <br /> o : <br /> y <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j'qm <br /> knowledge and belief it is true, correct and complete. I acknowle e r the detail and accuracy of QJ 0 c c <br /> all information contained in this application(including any a e ) I her declare that I recognize m m <br /> M <br /> that this information I am providing will be relied upon b i i I determining whether to is- O <br /> sue a permit. I further accept all liability which may be a ounty of Burnett r yi'ng on this information I am W: <br /> providing in this application. I agree to permit county ials charged with administer! county ordinances or other m <br /> authorized person to have access to the above describe emise time the purpose of inspection. T <br /> -n <br /> CD : <br /> SIGN HERE 01 J(�TM <br /> (signature of o ner or building cont ��,,;I r9� (date) <br /> 7 1 <br /> ZONING ADMINISTRATOR <br /> to fn Fn t»t» <br /> N Ln N 01 <br /> Ut ut O ut 01 010 O <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 o O �o <br /> 0 0000ojo <br />