Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v�/0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 4 <br /> r <br /> a <br /> w <br /> OWNER"r `/fir c <br /> -� a aY L(_L :T i r Q�b TELEPHONE <br /> m <br /> HOME ADDRESS •n �f'Y��i �,a `�_�n r ��`5 9 <br /> EMERGENCY/FIRENUMBE � .�h ROADNAME��7 ` R� I m <br /> 1 Cn <br /> LEGAL DESCRIPTION(see tax receipt) v! <br /> m <br /> c \ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> c <br /> v <br /> S. �. <br /> S. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION L <br /> CD <br /> STRUCTURE/ADDITION USE:r/_�A(/I Q Q 'J O �C �[J <br /> (H-o <br /> A/Cabin; Commercial Business; Bedroom;Deck;etc.) <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> x c <br /> DIRECTIONS FOR PLOT PLAN DRAWIN • (AERIAL OR TOP VIEW) T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m a <br /> NORTH(N). C 0 <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. <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 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. to <br /> c <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. oO <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. Di <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 /> A -0Qr' 0�0 .0 <br /> 6. JU <br /> a acg m <br /> ZI <br /> N: M <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my GG c ID <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy ofd i e <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize �m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 0 <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 admin* county ordinances or other m '. <br /> authorized person to have access to the above described premises at any reasonable fop a p, <br /> SIGN HERE r �? &' <br /> 1 i cc,1,�� <br /> (si e o ner or u(ding contractor) i d t 1I -SCI i <br /> AUG 2( �X97 <br /> ZONING ADMINISTRATOR <br /> u+wwwf MUl <br /> N N N N N t11 VI <br /> TOWNSHIP PERMITS MAY BE REQUIRE 0 0 0 0 0 0 0 <br />