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BurnerQounty 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v ci z <br /> * APPLICATION FOR jLAND USE PERMITS a <br /> aa <br /> OWNER r Q L h TELEPHONE _ <br /> v � <br /> HOME ADDRESS 7 <br /> EMERGENCY/FIRE NUMBER 7 gas ROAD NAME C ori <br /> �QU <br /> LEGAL DESCRIPTION (see tax receipt) G�33S- <br /> C M <br /> Cn5/6 y? ie6s 17.3 cd07 .�r;p <br /> `� oS s 7 P /5p cl, <br /> Q <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION a <br /> S. <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> m �' <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR _n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <br /> O o. <br /> o Z <br /> A <br /> 2. SHOW THE LOCATION AND SIZ L IN LDIIJGS(EB)AND ALE NEW m IF <br /> BUILDINGS(NB)AND INDICATE Cc) <br /> 0 <br /> 3. m v <br /> Z <br /> o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- Cj <br /> INGS, ROADS, LAKE, LOT LINES. Q} <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N b <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. c <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE q o <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o V <br /> CONDITIONS OF PERMIT: <br /> 1 <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 75 FEET OF THE OHWM OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. rn <br /> less fes^ I`/�/ +- <br /> � -00r' O Orn <br /> 6. /h�i All ' IGCS J-CJ ///,c- , v mC01 !00> 3_ <br /> JZ R N A 4 9 <br /> 7. O <br /> rn : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my a jo <br /> C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of v <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 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- y O <br /> sue a permit. I further accept all liability which may be a result of the C_ r Inilt[s information I am m E <br /> providing in this application. I agree to permit county officials char v�!�dmih�stelfi u :,o' ihances or other W : : <br /> authorized person to have access to the above described premises t it 41$2 ��parb d of inspection. _n <br /> m : <br /> SIGN HERE ' <br /> (sl <br /> of owner or Ing contractor) tote) <br /> ZONING ADMINISTRATOR COUNTY . . . . <br /> ZONING N N V N N (n Cn <br /> V1 (TO(T 0100 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0000000 <br />