Laserfiche WebLink
e�A C , <br /> Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator Q 4 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> 6/s8� t✓ <br /> OWNER o g ER r A • JE�sE�✓ <br /> TELEPHONE ,/'/;? —y3 Y—�t d`!1, d <br /> IF O <br /> HOME ADDRESS 13733 f4'✓AkC LAKE IRA Ii fT1bLWAr"f+Q <br /> 0 <br /> LEO^o/.✓r TCR A/Ie t- <br /> EMERGENCY/FIRE NUMBER ROAD NAME D r1 <br /> rJw,✓ OF 7 4PI- 03t'; <br /> LEGAL DESCRIPTION(see tax receipt) y0T �G S Nt VOA. 1✓r� D yG '��. 6 L f, fEL, yo s (b <br /> co <br /> TYPE OF PERMIT(S):DWELLING/BUILDING V1111- GARAGE/ACCESSORY STRUCTURE ADDITION or <br /> S `� 1 <br /> SANITARY. PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION y 0 <br /> STRUCTURE/ADDITION USE: ffOh� � �AB/✓ <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR G <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. a <br /> • _•AWING: (AERIAL OR TOP VIEW) n n <br /> DIRECTIONS FOR PLOT PLAN DR ,n o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. e <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m g <br /> C o <br /> NORTH(N). m rn <br /> o4 9 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDINGS)TO Z <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, o <br /> STREAM OR RIVER. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DFAND ALL DISTANCES TO BUILD- <br /> ), I ::E <br /> INGS,ROADS, LAKE, LOT LINES. I ' <br /> TO BE GRADED OR FILLED. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS 7 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS c <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE g <br /> ISSUED. <br /> Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 31 <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. C <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 /> � vCLU <br /> L m <br /> 5. �p �. m � m <br /> 6. a i a ai o : �m <br /> Zi AQ <br /> oN <br /> 7. m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of m, A <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize : m <br /> O O <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- . m <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 to <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 t evu =• ; <br /> SIGN HERE L E E E <br /> (sl of o er or building contractor) L <br /> ZONING ADMINISTRATOR `p h w to`A H <br /> (_ 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED O 0 0 0 0 <br /> - — <br /> y -6 C - <br />