Laserfiche WebLink
67) cu>7T, <br /> Burgett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator a G) <br /> p <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> a <br /> N <br /> c <br /> OWNER A //0 IV j Pt 5 O/J TELEPHONE <br /> O <br /> m <br /> HOME ADDRESS 7.?G 7e/ STfldc' N.GJ, <br /> r a <br /> EMERGENCY/FIRE NUMBER G' 3 76 ROAD NAME -De a i_!� I-AK(e Te,l!'))� <br /> C o e'RNm wT <br /> i <br /> LEGAL DESCRIPTION(see tax receipt)1e �s�� a3 a�' S/n U 2 -P 13 1 r-o T 5Secr c n .2 i C <br /> p,q Kc 4,vb 'twA <br /> e <br /> y 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION a <br /> N <br /> SANITARY PRIVY FILLING/GRADING 1/CAMPING UNIT SUBDIVISION :3 <br /> STRUCTURE/ADDITION USE: ifla r Fa i2 l� h-t � lir <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 < <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> 0 w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m $ �A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). N C <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <br /> a <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. ° <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. 2 r,l <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a ? XXJJY <br /> ISSUED. si <br /> w <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <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 PERMITTED. <br /> 5. <br /> ;avc�r o L <br /> a <br /> 6. Cgt , 53 <br /> ; : M <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 1 225 Cr : C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ,(;�[. o E <br /> all information contained in this application(Including any accompanying schedule)and I further declare that 1 recognize W: 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- m O <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 administering county ordinances or other E m E E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> m <br /> SIGN HERE <br /> (signature of o ner or building contractor) (date l <br /> ZONING ADMINISTRATOR �1/Y1 �1d til CI��CI <br /> h W""fa qa <br /> N N O�N N V7 Vt <br /> V1 V7 O N ut O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED Co 00 0o c o c 00 <br />