Laserfiche WebLink
A&W, <br /> Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator v c, z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> 0 <br /> OWNERft7�✓ TELEPHONE ��� _ �J����� o v 1 <br /> HOME ADDRESS Tr /fs� /' /1 S S­Y1S'� <br /> EMERGENCY/FIRE NUMBER ,7,!Y,.z 9 S— ROAD NAME ��,A y A!&O d <br /> LEGAL DESCRIPTION see tax receipt) 1co <br /> ( P)cty STA sFc? rmxl P-./sat,Ick,i <br /> Cn 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTUREADDITION C ' <br /> Cr �' <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> N c <br /> � r <br /> STRUCTURE/ADDITION USE: lir <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) a <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 r <br /> DIRECTIONS FOR PLOT PLAN WING: ERIAL OR TOP VIEW) O o <br /> N <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m f° <br /> NORTH(N). y 3 <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, t, <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. n 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. Ncs <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. o <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BEq 0 <br /> ISSUED. Cr <br /> I <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 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 1 <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 /> 6. lO'. < 3 a9 RL ;d <br /> 9 N C W y 0c_ <br /> 7. o <br /> y m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o Et <br /> all information contained in this application(including any accompanying schedule)and I fuer-declare that I recognize E E e m ; m <br /> that this information I am providing will be relied upon by the County of BurntscO�s7 termining whether to is- ' O <br /> sue a permit. I further accept all liability which may be a result r urns I i <br /> p p ty y of the �� � i�igr!this information I am `: m <br /> providing lwlftis�8 'on. I agree to permit county officials ch* i `kWi�steAnif-cou ordinances or other <br /> authorized person to h ve ac to the above d 'bed premia $gat a*'i;"sonable time for the OUrpose of inspection. <br /> m <br /> SIGN HERE -�— �'� PR 199b� <br /> /i ` <br /> (signature of owner or building contract COO date) (� <br /> ZONING ADMINISTRATOR ill 0) et ICIC U <br /> `7 Fn w fn w to <br /> `u� N N to N(n In <br /> (71 VIO OIOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 0 <br />