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gurnett 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 C <br /> N <br /> C <br /> a- -3is—yT4G0 <br /> OWNER TELEPHONE � � o <br /> HOME ADDRESS `7 Q l /�QG�/la�[Z 14We- <br /> EMERGENCY/FIRE NUMBER S C 79 ROAD NAME <br /> n' <br /> LEGAL DESCRIPTION (see tax receipt) �/Z/Q //� /S 6U 6ou. Lo� See.. 7 m <br /> 0 <br /> a <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORYSTRUCTUREADDITION ❑ PRIVY ❑ ° <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING <br /> 'UNITE] SUBDIVISION ❑ 5 <br /> CoA r C <br /> STRUCTURE/ADDITION USE: �va x 'q 0 <br /> (Home/Cabin; ommercial Business; B droom; Deck;etc.) ca <br /> BUILDING CONTRACTOR: fit <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR -n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) c \ <br /> 0 n <br /> T O Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 'o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m O <br /> NORTH(N). 0 <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 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. N O <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS 3. I <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN Ct n , <br /> NEEDED. 5L <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: C <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. —r <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 /> 4ETBACK AR j j(/A <br /> 5. �e h "f IC� YZ✓ 're 6e u Seq� QS r„� ;a ; d C& m <br /> 6. n�('a C)ahale,1s�'rc7e ,0 y� ,d/©7--4 �e Gf fell J_ / ' /ICLfl �' 'CD C N H O <br /> N O s <br /> o ; COD i rn <br /> —milli <br /> / -C' m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my roti G3� C <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n E <br /> all information contained in this application(including any accompanying schedule)and I 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- <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 m i <br /> providing in this application. I agree to permit my officials char ed with administering county ordinances or other e, <br /> authorized person to have access to the abo escr'bed pre ay'reasonable time for the purpose of inspection. -n <br /> io <br /> SIGN HERE <br /> signs of tamper 'build ontrac � at <br /> ZONING ADMINISTRATOR j ] ^fw w 40rrr///yy{������-in r� <br /> N N Ol1f.�N Ol V1 <br /> N U O 11,,pP+v�1I�Ut 0 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED o2�Cf��� o 0 0 0 0 0 <br /> 000 000 <br />