Laserfiche WebLink
-47 <br /> ,anty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator a o 0 <br /> '� APPLICATION FOR LAND USE PERMITS 3. <br /> -- <br /> V vl N O <br /> Ji <br /> ONER �� L- �C /� (/�T/" �f ��Lt" TELEPHONE�J`..�J�b(s�lL'`�7`•� / ^p <br /> O <br /> HOME ADDRESS ;7 7 //Jr) S.,q lvv /�, A,-zr XZ <br /> r <br /> 0 <br /> EMERGENCY/FIRE NUMBER oZ 4;g 7 ROAD NAME <br /> -� — or <br /> LEGAL DESCRIPTION(see tax receipt)j- Y_ �— / SG CT c.t� T0 -,oV,e .45 m <br /> C O I <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION X PRIVY ❑ <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ UNIT ❑ SUBDIVISION ❑ S. <br /> STRUCTURE/ADDITION USE: N c C� <br /> abin;Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: <br /> v <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR O 3 ` <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. y c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) n o. -tZ <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m d Y p <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C <br /> NORTH(N). N O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF c <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 <br /> BUILDINGS,ROADS,LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. 0 Ski <br /> N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS 7 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. 1° <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN W ' 1 <br /> NEEDED. <br /> Z I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: G <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT t <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I <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. y <br /> 6. N N O O f0 <br /> 0 <br /> 7. =y: m <br /> I declare that this application (including any accompanying schedule n examined by me and to the best of my C <br /> knowledge and belief it is true, correct and complete. I acknowle onsible for the detail and accuracy of Q a <br /> l` ; m <br /> ': <br /> d I further declare that I recognize <br /> all information contained in this application(including any acco ying W O <br /> that this Information I am providing will be relied upon by the C ty of Burn in in determining whether to is- m <br /> sue a permit. I further accept all liability which may be a result the Coof Ing on this information I am o <br /> providing in this application. I agree to permit county officials arge admi a unty ordinances or other m <br /> authorized person to have access to the above described premis any r s able ti o purpose of inspection. m <br /> l (D469 : <br /> SIGN HERE (date) <br /> ( n ure of o building co ractor) �i <br /> ZONING ADMINISTRATOR Al d'd 'A d'69 <br /> N N(TNN (T VI <br /> (J1 (T O (T [T O O <br /> 0 0 0 0 0 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />