Laserfiche WebLink
Burnettt'm <br /> y 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator � o° <br /> APPLICATION FOR LAND USE PERMITS 3. < 0 <br /> r <br /> w o <br /> / c <br /> OWNER TELEPHONE + p <br /> ?!� �y i= 4LG <br /> m <br /> HOME ADDRESS Q / / <br /> EMERGENCY/FIRE NUMBER AI ROAD NAME AyC,,^f &b , " <br /> LEGAL DESCRIPTION(see tax receipt) A10 _/�ej t � <br /> m <br /> � m <br /> TYPE OF PERMIT(S): DWELLING/BUILDING <br /> 0 <br /> _GARAGE/ACCESSORY STRUCTURE-ADDITION- <br /> (7 <br /> TRUCTUREADDITIONQ <br /> v <br /> n <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0' <br /> 'l d <br /> STRUCTURE/ADDITION USE: (►� <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) ' -I <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. r <br /> DIRECTIONS FOR PLOT PLAN DRAWING (AERIAL OR TOP VIEW) p C <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T v Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m IF <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 m 41v <br /> M) <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWOF LAKE, <br /> STREAM OR RIVER. Z <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. CIO <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. i GO <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS i <br /> MUST BE SIGNED AND DATED BY THE OWNER. g c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMITCAN BE <br /> ISSUED. g <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT i UI <br /> ISSUANCE. ( (� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. `v <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 /> s. Lake 87 ok hays 471(e-J r/., P/_sj-- N Adct�faati� lL a, ;eir <br /> _16?_ (AP10It&,� D! �f- *,-t I 101- � r�-4111 mavy yam- d? El as <br /> Elm o a v v <br /> .7. 4t, (0 c�7o,- `ta FJ e_ &oo8d � 1�Jt' SW LS AeIE n �rPJen t- Q C in `" 0 3 <br /> 1�0ryriecl gon.h -c��c�f/✓'� o w *0 <br /> i <br /> I declare that this application (im:luding any accompanying schedule) has been examined by me and to the best of my Zg Cr"i A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m ` C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize N m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- E G3 S E p <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 ^' <br /> providing application. 9 p g county ` 1 <br /> p gin this a lieation. I agree to permit county officials charged with administerin coon ordinances or other Co <br /> authorized person to have access to the above described premises at any reasonable time for the ur on. -n ; <br /> h m : <br /> SIGN HERE r' !D of A 4 w <br /> _�- store of ow r building contractor) 11 (date) ! �' <br /> ZONING ADMINISTRATOR I OCT 31RAWI1 <br /> '- ' , \ N ,INJI OfNJ� INJ1 OO <br /> TOWNSHIP PERMITS MAY BE REQUIReD 0 0 0 0 0 0 0 <br />