Laserfiche WebLink
fn cz <br /> Burnett County 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> ` APPLICATION FOR LAND USE PERMITS 3 <br /> c <br /> OWNER Gt a sl/ �4N2 u LEPHONE <br /> m <br /> '' /0� <br /> HOME ADDRESS �(� �D� ��/j�jC' 1 ( y S�-k gt� J A-) llI'S r <br /> EMERGENCY/FIRE NUMBER 1-700 ROAD NAME par 1 .. <br /> LEGAL DESCRIPTION(see tax receipt) <br /> 0 <br /> TYPE OF PERMIT(S):DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION—,Z_ t <br /> 5. <br /> w <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> or <br /> STRUCTURE/ADDITION USE: C a ki "J A I+era;bv <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) a <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. Ij Siy I t J O N <br /> c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 6f d o <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 O <br /> NORTH 3. SHOW D M)ENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m 3 <br /> 0 <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. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. oN <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS o• <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q ° ?V <br /> ISSUED. V <br /> t <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> I � t <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. R epalt- o-F e S ru ZC f Q�L I yl1J I- -to <br /> C-.0 Arf"h e-LaSe" <br /> r� f V z 'U 0 r �p c m <br /> 6. Tb OetuM G (C LUOr iV l J1I�(j s�- 3 NCL �F na <br /> V v � Cuwi !" o <br /> 7. 0 31 y <br /> co : rm <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 I am responsible for the detail and accuracy of a E S <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize ' m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m l7 <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 E <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other E m E <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. m <br /> CD : <br /> m : <br /> SIGN HERE <br /> (sign re f owner orb n ontractor) (date) <br /> ZONING ADMINISTRAT <br /> h N h to <br /> NNn Ci NN <br /> fn N O fJ1 U1 <br /> 3O 0 6 0 0 <br /> 6117 s TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 <br />