Laserfiche WebLink
"vV <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -U c) Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N <br /> CD <br /> OWNER - TELEPHONE ;71s--,:/3fe^ s C <br /> /!// m <br /> HOME ADDRESS 659/ /VOr S/t .C�%�St`%,IAkG Rd. Poavr. ? s-5/,�O% O <br /> 0 N <br /> EMERGENCY/FIRE NUMBER / ()C.. ROAD NAME <br /> ;a oa b <br /> see tax receipt) S�. T39loelVAI <br /> LEGAL DESCRIPTION t �Coi 2 <br /> ( p) -39-iY-ia- n 03yc>a esG U) <br /> CD <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITIONPRIVY L, I o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING CAMPING UNIT ❑ SUBDIVISION ❑ o: <br /> rn <br /> STRUCTURE/ADDITION USE: 0 <br /> (Home/Cabin; Commercial Business; Bedroom, Deck; etc.) <br /> D, <br /> BUILDING CONTRACTOR: <br /> C <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> 7 <br /> s-,r 9T-Ioer 5-)-11 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) !Jr, O m <br /> In <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m _�4 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO 1 <br /> BUILDINGS,ROADS,LAKE,LOT LINES. C> <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N Sul <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 0. <br /> MUST BE SIGNED AND DATED BY THE OWNER. ry� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN v o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: 0 <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 THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> X _U0r- > vavv <br /> CL <br /> f m <br /> 6. CD CD 7. <br /> CD <br /> ID <br /> 7. <br /> O <br /> - _ : A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) - e <br /> knowledge and belief it is true, correct and complete. I acFwhat I am responsible for the detail and accuracy of m 0m <br /> all information contained in this application(including any and I further declare that I recognize that this information I am providing will be relied upon by determining whether to is- <br /> sue a permit. I further accept all liability which may be a uthis information I amproviding in this application. I agree to permit county oed with a irti�t i u y ordinances or other <br /> authorized person to have access to the above described easonable time or urpose of inspection. fD <br /> m : <br /> 2 2001 <br /> SIGN HERE <br /> sig ature o ner or building contractor) Cou (date) Q <br /> ZONING ADMINISTRATOR �� QE E <br /> C) 0. <br /> TOWNSHIP PERMITS MAY BE REQUIREDm <br />