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RBurnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N O» <br /> CD <br /> OWNER �JC.Z e,s 5 ��5 TELEPHONE 6$q-31 s 1 0 iz.� <br /> HOME ADDRESS 6(3fTi�'�l!rC4 UILL 1-519�i r <br /> CDo <br /> EMERGENCY/FIRE NUMBER � a ��� ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) a CS y� V L� g i as_ �-r7 m <br /> 1 I�5 � <br /> rn 0=TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION Q <br /> n ! _ <br /> < V\J <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin, Commercial Business; Bedroom; Deck;etc.) -4 <br /> m rl <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR m � <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O o <br /> _n QQ z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m ti A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m 9 <br /> NORTH(N). o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD, (C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. P <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- <br /> INGS, 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 2 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ° Yom/ <br /> ISSUED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o VI , <br /> CONDITIONS OF PERMIT: NF1 <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 /> CD W CD CL m <br /> 5. <br /> .5 : 20 C y 0 0 0 �_ <br /> z N W O 9 � <br /> 7. o �1 <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my e5 c <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognizeCD <br /> M <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is G) : O <br /> sue a permit. I further accept all liability which may be a result of the I *I ' Mrs information I am m' <br /> providing in this application. I agree to permit county officials char ]�+•L r ordinances or other m E <br /> authorized person to have access to the above Odscribed premises a a 1 e ase of inspection. m <br /> o m ? <br /> SIGN HERE <br /> ( t r o owner or building contractors 8 da e) <br /> ZONING ADMINISTRATOR . . d, <br /> dr enf»f»cn cry <br /> ZONING NNP N N 00 <br /> � � ril (P <br /> � uoo <br /> TOWNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br />