Laserfiche WebLink
on ewwI <br /> Burnett Cobrv4f 7470 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 3 -01 o <br /> APPLICATION FOR LAND USE PERMITS - a TO THE.ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work <br /> d@scribed and located as shown herein. The undersigned agrees that all work shall be done in ccor- 3 g tN <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other - o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. n <br /> OWNER'( 1 � �1TELEPHONE et.)-A60 Al 7,y o <br /> H 6owF 6-e <br /> HOME ADDRESS a �! f SY 5+ _ vv G,,,e N" JS \ <br /> EMERGENCY/FIRE NUMBER :;1#Z-Z 7-9A1 ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) Lo- j CS M V S t l oil=„-(„U''- Lbh s}I,� r oyn, hef VW' <br /> w,•i-t... e 5 .`f 9 G <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION 0 rr^^ <br /> N 0 C <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a a <br /> i p <br /> C <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business;Bedroom;Deck;etc.) `J� r- <br /> 0 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE R <br /> In <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 III" <br /> O <br /> A 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 'n 7O in <br /> 1 m Z <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 <br /> North (N). M <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerl' e of m 1 <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM) of lake, stream or ver. <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buil ings, l SJ <br /> 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 m t be <br /> signed and dated by the owner. 4 <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE APERMIT CAN BE ISSUED. <br /> U\1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: a= <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I^ <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORE INE. Z <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY D <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET O THE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. /Uo qr-ackv.� 0' �Flk j ON 51.pc -row.4a l A-�e <br /> U � n a.,v. ( vti �u-IcE c„cPt J� hcQliTi <br /> 6. Sfr4Wh4 i cr �, I�e, cC 1' b !" � <br /> f y oc -o(nI;; >aEm <br /> 7. a �D y. 2 N O 79 <br /> 9 <br /> 00 Z <br /> GF El : i _ N : ,TJ <br /> v,: m <br /> 6. ci» ' O <br /> o : 0 C <br /> P ' m m 9 <br /> o : <br /> L7 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the est of my y ; G <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of No o <br /> all information contained in this application(including any accompanying schedule)and I further declare that recognize o m o <br /> 0 6 : <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining w ther to Is- . <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Info ation I am 3 <br /> providing in this application. I agree to permit county officials charged with administering county ordinane s or other y <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of I ispection. 6n <br /> m <br /> OL <br /> SIGN HERE QQ.7.r� 57 Y3 o <br /> gn ure of ner o bu ding contractor) ` Date) <br /> o <br /> ZONING ADMINISTRATOR <br /> % !1f OP O91 (NP (P <br /> i TOWNSHIP PERMITS MAY BE REQUIRED!ii Its $0 0 0 0 0 0 <br />