Laserfiche WebLink
Onlaylp <br /> Burne'8 County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator a. o <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N <br /> C <br /> (D <br /> m► 1 r- 8b1�-�05 <br /> OWNER - TELEPHONE <br /> W <br /> HOME ADORES S �3 ? 0 <br /> / r m <br /> EMERGENCY/FIRE NUMBER �$a� ROAD NAME o <br /> LEGAL DESCRIPTION (see tax receipt) <br /> DWELLING/BUILDING ❑ GARAGE/ CESSO TRUCTURE ❑ ADDITION ❑ PRIVY ❑ U1 O <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ (�- a <br /> STRUCTURE/ADDITION USE: _���. IO X <br /> o JU <br /> (Hom /Cabin; Commercial Business; Bedroom; JDeck;etc.) or <br /> BUILDING CONTRACTOR: - <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O Q <br /> n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m a <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o � � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN " ° <br /> I <br /> NEEDED. <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 <br /> ISSUANCE. O <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 /> A -0n � >ov <br /> M m = m � m <br /> M. <br /> m C91110' <br /> � 3 <br /> o <br /> 7. z <br /> P : N °� � 1 <br /> 1 o) m <br /> I declare that this application (including any accompanyin examined by me and to the best of my (j p <br /> knowledge and belief it is true, correct and complete. I ac led stole for the detail and accuracy of a � C <br /> all information contained in this application(including an ompanying a er declare that I recognize m m <br /> that this information I am providing will be relied upon Coun of BurneVI r de ermining whether to is- <br /> sue a permit. I further accept all liability which may be a r ult of teunty�f Burne n this information I am c 1 m' <br /> providing in this application. I agree to permit county offs IS charged v1it1>7ac�r��sterin my ordinances or other m <br /> authorized person to have access to the above described pr a ,ny reasoftii(flWtime rthe purpose of inspection. m <br /> fD <br /> SIGN HER ZO coup M (Q <br /> (signatur o w 1 ontractor) r (date) <br /> 40 64 4A <br /> ZONING ADMINISTRATOR <br /> (� NON (1 <br /> TOWNSHIP PERMITS MAY BE REQUIRED oQa� 0 0 0 <br />