Laserfiche WebLink
Surriett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator U 0 o <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> OWNER n �J K I ' n <br /> �0 �rYI H7 /JYl) 1997 1 HONE( <br /> HOME ADDRESSp � A. _ ! I S /$7 O <br /> EMERGENCY/FIRE NUMBER ROAD NAMEo` <br /> S <br /> LEGAL DESCRIPTION (see tax receipt) GU � <br /> CD <br /> DWELLING/BUILDIN GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ I ti o <br /> TYPE OF PERMIT(S): � <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ n <br /> STRUCTURE/ADDITION USE: a�O oZ 61222,C /1p X �b < <br /> N <br /> O <br /> ( abin; omm al Business; Bedr m; Deck; etc.) W <br /> BUILDING CONTRACTOR: l2. <br /> �.Lc�lP�a�� <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8Y:X 11 SHEET OF PAPER. ANY INCOMPLETE OR CD3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. nn T — <br /> � �CC Y (� O <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p CD <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. L)(�� n 0 <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINB)AND INDICATE m <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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. I o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO ZI <br /> BUILDINGS,ROADS,LAKE,LOT LINES. ) <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N 0 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS �0 Q <br /> MUST BE SIGNED AND DATED BY THE OWNER. 2 o <br /> F 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN o O <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. z <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. z) , 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. �t <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. ry y <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER /� 0 /`yJ <br /> 5. <br /> SETBACK �T S( �YLGY �///1 <br /> ( E m <br /> 6. m 3 a n <br /> m <br /> F <br /> (D C: ^ o 3 <br /> 7. Z : NCDO �� =1 <br /> o T < M <br /> - <br /> _ A <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my G1 C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 0 m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- a m C <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized pe on to have access to the above descri d premises at any reasonable time for the purpose of inspection. m <br /> •� m <br /> SIGN HER q_ <br /> (signature of ow r o building contracto (date) 0 5 <br /> ZONING ADMINISTRATOR / <br /> g . <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />