Laserfiche WebLink
� o o <br /> Burnett Cuunty 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator <br /> G. APPLICATION FOR LAND USE PERMITS 3 <br /> \ a N <br /> OWNER V\ 1 G i-I P Z7L�lj4 h, TELEPHONE <br /> /J�� <br /> Tr <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER g�,z ROAD NAME NbC r Si'iR�TL�kEK� I <br /> LEGAL DESCRIPTION(see tax receipt) <br /> v <br /> Vl 0 '0 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION or <br /> n ZZ <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION H <br /> V) O <br /> � Z <br /> Aj <br /> STRUCTURE/ADDITION USE: lir Ln <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR m 3 w <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 Q O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m 'o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y v 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m I <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, I M Z <br /> STREAM OR RIVER. 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. o <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <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. m' e <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Cr <br /> ISSUED. <br /> i <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P CC <br /> CONDITIONS OF PERMIT: <br /> i <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 /> • <br /> 6 SEE VARIANCE #606 mm�Q Uan&AQ. � 'o a m <br /> » it Lo' �ic3 <br /> y; ; : M <br /> m <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my ZS c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of aLrE E S <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m B m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m v <br /> sue a permit. 1 further accept all liability which may be a result of the County of Burnett ormation I am m <br /> providing in this application. I agree to permit county officials chap—Al �r n ces or other m E <br /> authorized person to have access to the above described premises a a eI o Inspection. <br /> SIGN HERE {�� �✓L/ Rb I� <br /> (signature 2 <br /> of owner or building contractor) 7 ( e) <br /> ZONING ADMINISTRATOR <br /> N N V• NNNN <br /> �ptVt�4G 00o00oo <br /> TOWNSHIP PERMITS MAY BE REQUIRE 0 0 0 0 0 0 0 <br />