Laserfiche WebLink
Burnett County T00 Co.Rd.K,No.M,Siren,WI 54872 Office of Zoning Administrator 'D G) <br /> APPLICATION FOR LAND USE PERMITS . 4 <br /> OWNER RQ! h 5h/dler Um 6a�5 a19-8 q9- J67i <br /> 8 <br /> DD TELEPHONE <br /> QaK Rada e ZNN Resort m = (� <br /> P088A Medaryville 1'N H 79,4'7 O <br /> HOME ADDRESS 0al< Lo - " 31 V <br /> . 9 <br /> f I / <br /> EMERGENCY/FIRE NUMBER ROAD NAME W (j L�� I <br /> N-5 +leaflj9 5-1� acs Sn9/tNl/R/ k/ hge6 3s, 100 C <br /> LEGAL DESCRIPTION(see tax receipt) 3-N — 0 1 0o GoV tot 5 e'X t.$ V !06 P 1, <br /> �X y <br /> TYPE OF PERMIT(S):DWELLING/BUILDING GARAGELACCESSORY STRUCTURE ADDITION c ' <br /> cr <br /> 5. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o'� <br /> r rn <br /> STRUCTURE/ADDITION USE: Eelrl _sed n.G 3; sow pore I�IX�� i <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) 13 i <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> x w <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). (A 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, 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. w <br /> 17 <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 6410 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 3 / <br /> MUST BE SIGNED AND DATED BY THE OWNER. ro o �} <br /> c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Cr <br /> ISSUED. T <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P (N <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 <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. f' -44 FioC lc� Po-/� /SQL �,-� <br /> 6. S n TG V'Ck�Lc m� C m <br /> f✓L�r(L t 1' u.� n �zC ��,� P�-��[J Q(.�r�-•�, .7�.oL�� � �crE�� � ,� 3 n <br /> / e_ <br /> X0000o 33 <br /> 7. o F <br /> =_Ca '• '• m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 10 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <br /> ate : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 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 a <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Information 1 am �: m <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other m E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. „ . <br /> SIGN HERE <br /> (51 atu of owner or ng contrac r) + (date) <br /> ZONING ADMINISTRATORCn <br /> 6►6►w w <br /> Vt Poo <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 <br />