Laserfiche WebLink
Burnett Cpunty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning l�ministrator o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> ` y O <br /> N .. <br /> b /^ <br /> OWNER �� �r—� �p e � TELEPHONE <br /> v <br /> HOME ADDRESS O l 'Rj, 4, W eOS Wl sli-0 <br /> EMERGENCY/FIRE NUMBER 3 90 ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) e S� VI q -1 + 4 / „ts �D� �c y <br /> P4 �-� e �++ <br /> l SS o, 0 T <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE-ADDITION-X-- C ' <br /> Cr <br /> S 70 <br /> T b ,3 <br /> ,3 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> y <br /> J�_ � � f] /' / tii lA <br /> STRUCTURE/ADDITION USE: WIYUi'6P.aJ a^ 6 k3`/ <br /> r (D <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) �o C _� <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR n 3 — c <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. �� L <br /> see uarta_rucazbL 47DL/ 0 IV- <br /> M o <br /> mb <br /> DIRECTIONS FOR PLOT PLAN DRAWING' (AERIAL OR TOP VIEW) O m <br /> m a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <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 3 <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. 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. N Y/ <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. <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BEa 0 <br /> ISSUED. w f� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z Q <br /> CONDITIONS OF PERMIT: c LA <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Li <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 UN SS SPE IF CALLY PERMITTED. <br /> 5 ���/�" <br /> 5 din, 9 1i -o rer�w � per S�6- - j P <br /> CD v c)r Q m <br /> COD� <br /> r m <br /> I declare that this application (including any acco panying schedule) has been examined by me and to the best of my G)c j p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of @ c <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizeCD <br /> m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ID <br /> O <br /> sue a permit. i further accept all liability which may be a result of the County of Burnett relying on this information I a 'm <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T <br /> m . <br /> CD <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR u/(Yl ►�%�(( /��� <br /> VCn N O ,Uht "J�00 <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 o c <br />