Laserfiche WebLink
(yn-c-n-)ILP <br /> Purnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> _ r- <br /> 0 <br /> C <br /> `...� —_ ,W1 TELEPHONE / ,J J y OWNER N <br /> HOME ADDRESS 3g�5 SG�Sacca4 ��11< ��yM to��� <br /> r � <br /> �}_ 0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> t.o 2 ova t,pn pygc,Ei <br /> LEGAL DESCRIPTION(see tax receipt) <br /> Q, L4 ki dA\,I 1S LA'XN� 1 <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE El ADDITION El PRIVY C/) 0 <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <br /> H <br /> STRUCTURE/ADDITION USE: C�cti\0 3 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) rn <br /> BUILDING CONTRACTOR: IN <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> U) <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) c <br /> n ii <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 C n <br /> NORTH(N). y G <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. <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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS o�+ <br /> MUST BE SIGNED AND DATED BY THE OWNER. -11�j o,\0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERfFICATION MAYBE DONE WHEN iX S <br /> NEEDED. \I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q) <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 1 <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. z <br /> M. mo�om <br /> m �. � mn <br /> Z R m 2 <br /> 79 <br /> =i <br /> 7. oy : .77 <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of nEr <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- 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 a <br /> providing in this applic ' . I agree to permit county officials charged with administering county ordinances or other m <br /> authorized personterflaveAccess to the above described premises at any reasonable time for the purpose of inspection. T <br /> CD <br /> SIGN HERE <br /> 41Zg1�� <br /> (signature of owner uilai I (d4e) <br /> ZONING ADMINISTRATOR <br /> ww�nwv+w <br /> 1 <br /> N N (JtNN(T <br /> (11 UI O G1 (T O O <br /> O 0 0 0 0 0 0 <br /> TOWNSH P PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />