Laserfiche WebLink
on cam-,-tip <br /> Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator -it o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> t G � <br /> OWNER r_ ar I �. a Nclar TELEPHONE 6 )Z _ y93-Z?33 m <br /> ( O <br /> HOME ADDRESS f S nM w e/ Dc. C n ., _ IVOr�I, (�a L's MN S'/Z 7 or <br /> EMERGENCY/FIRE NUMBER 279&Z- ROAD NAME Le'er gogJ ~ <br /> 'LL `T LIO Al R 19W -TO um 0 '-rda-c. 0 b, <br /> LEGAL DESCRIPTION(see tax receipt) +r1G I 2 L e i L GSM I y v, f�� o <br /> 0 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION ii <br /> CL <br /> S. <br /> �. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION � <br /> CA <br /> STRUCTURE/ADDITION USE: 61� r rad e, ��T0.�r r nq WLL I fa (n <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. <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 jo <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C fir 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 rn 3 <br /> 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. <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. �'c c su <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE Cr <br /> ISSUED. <br /> C <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <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. C�Cm <br /> A O <br /> MQ <br /> J <br /> m <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my QE g C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ii <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize o m <br /> PP ( 9 Y ) 9 E m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is- y <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 n <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> CD : <br /> SIGN HERE <br /> (signature of owner or building contractor) ate) <br /> ZONING ADMINISTRATOR - )fifn rldn l/A . <br /> . h <br /> HHHh4fttn <br /> N NNNN tTN <br /> N 71ONfJ1 OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />