Laserfiche WebLink
r <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 'v 0 z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r Q , <br /> UT o v <br /> OWNERP064 y I TELEPHONE �(;rz) ySS- 3908 d <br /> /4/ <br /> I �r (. , r/ 2NVE2 C.7/�ovQ j++5- Ero <br /> HOME ADDRESS 3 3 .S Vc �7�Q 0 Vl/A ] MW S"SO7(o � 9 <br /> m <br /> EMERGENCY/FIRE NUMBER ROAD NAME So Shoggir DRI V <br /> 0 Ir <br /> LEGAL DESCRIPTION(see tax receipt) BASS t.41<41F $ o/2.jiwS poo" wa '07•o-%- ,�•y0 I7 o/ o m <br /> oiSoo c <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—X--GARAGE/ACCESSORY STRUCTURE—ADDITION— <br /> or ' <br /> CL <br /> N' �- <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION O <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Boom; Deck;etc.) CD <br /> .o <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O _ <br /> W O <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) O o <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n obi A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m !" <br /> NORTH(N). C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m9 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 1 0 <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. ) Q <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. I� c (� <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS 1 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> 4 v 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q 0 <br /> ISSUED. F <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> o � Q <br /> CONDITIONS OF PERMIT: _ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1 n <br /> ISSUANCE. vim' <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. 1 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 75 FEF1 . F THE OHWM OF LAKES, <br /> PONDS, RIVER UNLESSQ SPECIFICALLY PERMITTED. <br /> pQ S <br /> nn <br /> 6. m <br /> 6. m � B C: <br /> mcm �" oS � <br /> JAN 0 <br /> o : <br /> =cn: m <br /> I declare that this application (including any accompanying schedule) has been exa me and o pest of y- <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsib tS tail a teura m C <br /> all information contained in this application(including any accompanying schedule)and I fu t I rec CL <br /> ze m . m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in er Is. v <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on t information I am m <br /> providing in this a 1 agree to permit unty officials charged with administering county ordinances or other m E <br /> authorized perso to have acc s tot bov a ribed premises at any reasonable time for the purpose of inspection. r <br /> CD : <br /> Q m <br /> SIGN HERE ^��- - 3 - <br /> (signature o owner or building o tor) (date) <br /> ZONING ADMINISTRATOR <br /> �'t»f»fnfncncn`� <br /> N N (TNNfIN <br /> (T NOUI ITOO <br /> WNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />