Laserfiche WebLink
Burnett County 7410 Co. Rd. K, No.102, Siren,WI Office of Zoning Administrator - a Z <br /> APPLICATION FOR LAND USE PERMITS 91 <br /> 3 <br /> r <br /> w 0 <br /> N <br /> OWNER <br /> LID ftAnr• 'PED6RS0'4/ TELEPHONE ��/Z) 94 90044 o <br /> HOME ADDRESS 972 L9 �� ST (�LA/NE /y)/V <br /> r � <br /> 0 <br /> EMERGENCY/FIRE NUMBER �BZ� ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) w <br /> m <br /> N <br /> o <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE X ADDITION 01�0� <br /> c <br /> CL <br /> 5. <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> m <br /> m <br /> STRUCTURE/ADDITION USE: /.Z STa'CflloF cyoo ��X 20 c � <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) n <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR n <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. "n <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 T) <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C Ci <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, 13Z <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. m o <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BECt <br /> ISSUED. <__ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. e <br /> CONDITIONS OF PERMIT: 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 /> rucbc� -� awg <br /> w � E <br /> q0 a <br /> 6. res a9 m <br /> v : Cw m o 3 <br /> .. <br /> o : <br /> m <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my N ; ? C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize Ri CD <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. m <br /> m : <br /> m : <br /> h : <br /> SIGN HERE <br /> (sl na o wnerorbuil contractor) j (dat ) <br /> ZONING ADMINISTRAT <br /> wwv.ww� <br /> V 1 O N N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />