Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator 0_V G) o <br /> APPLICATION FOR LAND USE PERMITS 4 <br /> 0 <br /> q/� At D/� PJA - 1,,1� hyo /y�2 CL <br /> C <br /> OWNER Yi S �NV(!1Y A. ILf 1✓� <br /> �� ELEPHON <br /> HOME ADDRESS ILS) LJ tjjl� i `/�I� �f Q(� jqAt L;—r, <br /> —r, o 0 <br /> "�s .lam V ° � <br /> EMERGENCY/FIRE NUMBER / v ROAD NAMERA/Ajb LA <br /> LEGAL DESCRIPTION(see tax receipt) FC L C Q V, % 0) <br /> 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDINGGARAGE/ACCESSORY STRUCTURE ADDITION o1 ' <br /> c <br /> S. <br /> CL <br /> S.La <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION— <br /> STRUCTURE/ADDITION <br /> UBDIVISION STRUCTURE/ADDITION USE: <br /> L4_4&JAI )9Db1710AJ ; a SED OW 84 TY w <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In c. <br /> .'0 w <br /> DIRECTIONS FOR PLOT PL6N DRAWING- (AERIAL OR TOP VIEW) 0 <br /> -n a <br /> T 2 <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 6 <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO M <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, 3 <br /> STREAM OR RIVER. o <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 r <br /> MUST BE SIGNED AND DATED BY THE OWNER. c v <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q o <br /> ISSUED. C <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c d <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 /> X -0nr o�ov <br /> 6. m M, 3 a <br /> c m <br /> 7. COD 'f° 1 <br /> P <br /> N: .a <br /> I declare that this application (including any accompanying schedule ha a and to the best of my v Cr p <br /> knowledge and belief it Is true,correct and complete. I a s f e detail and accurac of a " C <br /> all information contained in this application(including an I declare that I recognize mm m <br /> that this Information I am providing will be relied upon by a Wisconsin I d termining whether to is- E p <br /> sue a permit. I further accept all liability which may be a It of the County of Bur tt rely g on this Information I am m <br /> providing is application. I agree t pe it county o s charg{prith�rrering hty ordinances or other ,mo <br /> authorize pers to have access o abo a described p sea at Cfeasonable time fo purpose of Inspection. T <br /> SIGN HERE )tow ys�_O� 13URNETT COU <br /> (signature of owner or uil(bng contractor) Z0141m (date) <br /> ZONING ADMINISTRATOR <br /> fnwwwwuw0 <br /> N N'T N N <br /> tT NP fn P 0 P0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />