Laserfiche WebLink
SurnettrCounty 7410 Co. Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator g! o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> w � n <br /> OWNERI 1° P/j41� /! , TELEPHONE � / Z9 x� <br /> v <br /> // � (� Q 8 Z <br /> HOME ADDRESS �" l�u-L �p 3D <br /> 1 .,�,C.l�l�� o <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> 1 <br /> LEGAL DESCRIPTION(see tax receipt) — ��— �b /S� Md <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY <br /> ❑ ) W 0 <br /> C <br /> TYPE OF PERMIT(S): Cr <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVIS / �.^' S. <br /> STRUCTURE/ADDITION USE: CJ C�hl <br /> (Home/Cabin; Commercial Business; B room;Deck;etc.) m <br /> BUILDING CONTRACTOR: <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> � c 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> ?I O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE M 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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. c <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 /> 6. 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 -01 <br /> C <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN 5 <br /> NEEDED. O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o i <br /> CONDITIONS OF PERMIT: n` <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ^� <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 THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> � = 3 =a ex <br /> 6. VCAH, Ho& <br /> Z : m =O <br /> 7. c rn: i m <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my c p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> n <br /> S <br /> all Information contained in this application(including any accompanying schedule)and 1 further declare that I recognize �� 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 <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. r <br /> - : <br /> m <br /> SIGN HERE <br /> (signature of nor or building eon r) (date) <br /> ZONING ADMINISTRATOR <br /> v,tnwtn tnw0 <br /> N NtTNNN 0 <br /> V1 (T O N V1 O O <br /> O 0 0 0 0 0 0 <br /> 4WNSHIP PERMITS MAY BE REQUIRED (30 0 0 0 0 0 <br />