Laserfiche WebLink
crn c <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 64872 Office of Zoning Administrator -0 o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> -• r <br /> FL <br /> OWNER jLf� t4 &kE-j 1) u 8 VI G TELEPHONE �/Z_5/34_ da y� m � 1 <br /> HOME ADDRESS 109 It PZ/ AJr�,kl_ D 4t)2) : Cr/RGI A), S�/CCG/�Tf�°///i%SSOS�Z 0 <br /> r n <br /> 0 <br /> EMERGENCY/FIRE NUMBER o2g$ $� ROAD NAME <br /> \ <br /> ��o� <br /> LEGAL DESCRIPTION(see tax receipt) D <br /> asp -Dl-� � Q�G y <br /> N � <br /> TYPE OF PERMIT(S): DWELLING/BUILDINGGARAGE/ACCESSORY STRUCTURE ADDITION <br /> Q <br /> a' <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> m <br /> 9. <br /> STRUCTURE/ADDITION USE: <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 I <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> M coal d <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T <br /> 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). to o <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, 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. `r Q <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. Jj <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS ° j <br /> MUST BE SIGNED AND DATED BY THE OWNER. m o <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. 2 \ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z �O <br /> CONDITIONS OF PERMIT: <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. d \ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Ir <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 /> z _ 31 I MX <br /> p <br /> �i a m <br /> 6. o' 'aCwc' oS1C <br /> 91 mo7. 0u BI Z <br /> ` ca i : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my I ZS g C <br /> ul i <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the d it and accuracy of o. <br /> all information contained in this application(including any accompanying schedule)and I §that I recognize E : m m : M <br /> M <br /> Is- <br /> that this Information I am providing will be relied upon by the Cou4of4asonable <br /> (Vll@dds i g whether to is- �E m E O <br /> sue a permit. I further accept all liability which may be a result of r n Information I amproviding in this application. I agree to permit county officials c ng county ikiances or other m <br /> authorized person to have access to the ove described premisetime fort a pur of inspection. .n <br /> APR � S 8 m <br /> SIGN HERE � <br /> signatu <br /> re of owner or it g ntractor) GO (date) <br /> ZONING ADMINISTRATOR 40 SING fp 40{q H N N <br /> IN N tri N N m tT <br /> to O to tri OO <br /> TOWNSHIP PERMITS MAY BE REQUIRED 000000 <br /> 0000000 <br />