Laserfiche WebLink
on _m. . r . <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator I o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER TELEPHONE '7/5 7.2&- 3 A?-? <br /> HOME ADDRESS 3/9 G/�GD/fir-, z/� � S (/`' /• <br /> o 9! <br /> oe EMERGENCY/FIRE NUMBERrIA'e �onLSe�W/ ROAD NAME I Z' <br /> .. <br /> LEGAL DESCRIPTION(see tax receipt) L•DT.D cSAI ✓`I Paa4t;/I GD✓. LOT" y <br /> j I0 <br /> N <br /> TYPE OF PERMIT(S):DWELLING/BUILDING_)�—GARAGE/ACCESSORY STRUCTURE ADDITION `or <br /> n <br /> Lo.' <br /> SANITARY PRIVY FIL ING/GRADING CAMPING UNIT SUBDIVISION 0 _ <br /> —afAcon N <br /> STRUCTURE/ADDITION USE: I Ei <br /> (Home/Cabin;Commercial Business; Bedroo ;Deck;etc.) a <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR In I <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 <br /> ?IZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m S �A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C n <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, 41 Z <br /> STREAM OR RIVER. 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. ) <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. m c <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 5 <br /> ISSUED. st <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <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 SHORELINE. <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 /> 5. <br /> M � m = i Im <br /> n <br /> 6. '� .o Cwa EE <br /> _vr : : M <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of o E <br /> all information contained In this application(including any accompanying schedule)and I further declare that I recognize m m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- ; m 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 am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other E m E <br /> authorized person have acces the above described premises at any reasonable time for the purp se of Inspection. m <br /> o : <br /> Z� <br /> -F <br /> SIGN HERE <br /> (signat6fe of owner or building contractor) r�llj date) <br /> ZONING ADMINISTRATOR — <br /> ImWww <br /> TOWNSHIP PERMITS MAY BE REQUIRE 0 0 0 0 <br />