Laserfiche WebLink
nz %exA_p <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> 0 (� , <br /> m � wN <br /> C <br /> p W <br /> OWNER L �/�b y 4V r L FST,C f� TELEPHONE I�ri s✓ o <br /> l � <br /> ST <br /> HOME ADDRESS t,'7 Lc -��� H 2n cx f- <br /> EMERGENCY/FIRE NUMBER 7 ROAD NAME _4.,!fT A <br /> LEGAL DESCRIPTION (see tax receipt) 6 Ls �UCn <br /> rn 0 <br /> 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION <br /> v 1, <br /> a f` <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> m <br /> m <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; CAmercial Business; Bedroom; Deck; etc.) <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. _n N <br /> .'O v <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n n <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 <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 m 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. P <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 2 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o C <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 0 d <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z Q <br /> CONDITIONS OF PERMIT: P <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. Ott (111��� <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. ;avnr- > C) 0 .0 <br /> � N C N N O <br /> 7. Z . " < . <br /> � O <br /> —m : m <br /> I declare that this application (including any accompanying schedule) has been ex i dAy and to Ame'best of my cj c c <br /> knowledge and belief it is true, correct and complete. I acknowledge that�)J onsible�Y(o etail accuracy of �) n <br /> all information contained in this application(including any accompanying scht�ll urther eclat t I recognize m A <br /> that this information I am providing will be relied upon by the County of Burne fifi�Q i rmi n hether to is- \ 0 <br /> sue a permit. I further accept all liability which may be a result of the County ob�I is information I am �: m <br /> providing in this application. I agree to permit county officials charged with administen county ordinances or other CD <br /> o <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. r '• i <br /> m : <br /> t (D : <br /> SIGN HERE qX <br /> si nature i i <br /> of owner bung contractor) (date) <br /> i <br /> ZONING ADMINISTRATOR Al <br /> �N NONNCIiU <br /> N O Nf1100 <br /> TOWNSHIP PERMITS MAY BE REQUIRED UO 0 0 0 0 0 0 <br />