Laserfiche WebLink
(6 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o� o <br /> APPLICATION FOR LAND USE PERMITS 4 <br /> r <br /> N 0 <br /> OWNERTELEPHONE`12 <br /> 7a'-3 q,7_ _S-,77.2 <br /> ��2e14Q �11► /4uF. n1 ra <br /> HOME ADDRESS &V GD EN VR[.L,E f MN SSS�.ti 7 I <br /> r me <br /> 0 <br /> EMERGENCY/FIRE NUMBER '2-(-/ S 171 2 ROAD NAME �{ TrE� p7: P <br /> LEGAL DESCRIPTION(see tax receipt) � 3�I L,f ( <br /> o <br /> N 0 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION Cr <br /> o. <br /> w• <br /> SANITARY PRIVY NLLING/GRADING-CAMPING UNIT SUBDIVISION 0 <br /> y <br /> STRUCTURE/ADDITION USE: 9E Er <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 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In ^� <br /> 0 a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> T o. <br /> In Z <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 C n <br /> NORTH(N). N 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. c <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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS Q <br /> MUST BE SIGNED AND DATED BY THE OWNER. o N <br /> o su <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a S G <br /> ISSUED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z ) <br /> CONDITIONS OF PERMIT: 0 0 <br /> ;v 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 /> A � dr oaL <br /> 6. 3o ImZ <br /> � � '_ <br /> v : c0i !" o9 - <br /> 7. Z ' N �� � <br /> o : <br /> y: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ; p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a` c <br /> all information contained in this application(Including any accompanying schedule)and I furt des{are that I recognize m ; m <br /> that this information I am providing will be relied upon by the County of B sE I r mg whether to is- G): p <br /> sue a permit. I further accept all liability which may be a result, C64 urp' tR��ly Information I am d <br /> providing in this application. I agree to permit county offlcials4 r +�)j+�/ I�eiVd9 n dinances or other m <br /> authorized person to have access to the above described premia re sonable time for the p se of inspection. T <br /> n{� <br /> c Qe / <br /> CD <br /> SIGN HERE OR 6 �77�I v�� N <br /> (sl re o owner orA6lIdIng contracto) GouN-I Y (date) <br /> ZONING ADMINISTRATOR ' !' /J��� BORNE tv <br /> N <br /> M MNNMN-" <br /> NN NNU1N <br /> NOfJ� N 00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED x 0 0 0 0 0 <br />