Laserfiche WebLink
Syrnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v Z <br /> APPLICATION FOR LAND USE PERMITS 3 4 <br /> r <br /> I � � 1 N T <br /> OWNER I D, TELEPHONE <br /> -Sb 7-73 Cil gjZ�S o <br /> HOME ADDRESS / ��,�� �C N W ULde )MA.., ,$ 02,3 0 <br /> D <br /> r m <br /> �I <br /> EMERGENCY/FIRE NUMBERROAD NAME /� o <br /> �Lc-( a � S�j <br /> LEGAL DESCRIPTION (see tax receipt) f u C L� a(j, m <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ o ' <br /> TYPE OF PERMIT(S): i y <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> <, <br /> STRUCTURE/ADDITION USE: 8M X 0 s <br /> o' <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) m <br /> BUILDING CONTRACTOR: fit <br /> �(I�m" <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 6'/2 X 11 SHEET OF PAPER. A COM <br /> LET <br /> E O L 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O/ti O • . <br /> l�* <br /> DIRECTIONS FOR PLOT PLAN DRAWIN (AERIAL OR TOP VIEW) CLQ r 'a t��� ' mr tvi N �l <br /> oL <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. )3 TF 10'-�T fP F n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m ;? <br /> NORTH(N). <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 n ~ <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ` o <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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS pG <br /> MUST BE SIGNED AND DATED BY THE OWNER. c l <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Sq 0 <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: 0 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT �l ` <br /> ISSUANCE. lY <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 /> � vc� o� ov <br /> m m o+ m m <br /> 6. io3 nma .'0 <br /> e <br /> a N C N y C J <br /> 7. Z : mCOD o ' <br /> O <br /> =yt m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 0 : C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizeCD m M <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- p <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 <br /> m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other � <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> m <br /> m <br /> SIGN HERE <br /> (signature f owner or building co a or) (date) <br /> ZONING ADMINISTRATOR <br /> N N N N N U 1 N <br /> VtON VtOO <br /> WNSHIP PERMITS MAY BE REQUIRED o(r <br /> 0000000 <br />