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Q� Nry nistrator 3 o Z <br /> Office OT �yI�SC ED 3 o <br /> ett County 7410 Co. Rd. K, No. 102, Siren,+lVl 54872 e r <br /> APPLICATION FOR LAND USE PERMITS y ° <br /> TELEPHONE /j <br /> OWNER�t GLl/f i► �flI/l�'� �" <br /> O <br /> HOME ADDRESS � <br /> ROAD NAME <br /> EMERGENCY/FIRE NUMBER <br /> LoT -x t i"r /l 1/ V Cn <br /> LEGAL DESCRIPTION(see tax receipt) N G' d 41 7` N o <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ADDITION ❑ PRIVY <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNITE] SUBDIVISION ❑ �+ <br /> a� a <br /> STRUCTURE/ADDITION USE: ur <br /> ( ome/Cabin; Commercial Business; Bedroom;Deck; m <br /> J (G <br /> BUILDING CONTRACTOR: b <br /> kip, <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INC PLET <br /> 2002 3. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. BURNE77 COUNrY p ; r <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) ZON�(�O -mn o Z <br /> n m <br /> M ' <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE co 3 <br /> NORTH(N). m <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LIN10 <br /> ES,(B)BUILDING(S)TO <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF c <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> SEPTIC TANK(ST)AND DRAINFIELD(DF), <br /> AND ALL DISTANCES TO <br /> 4. SHOW THE LOCATION OF THE WELL(W), N <br /> BUILDINGS,ROADS,LAKE,LOT LINES. o <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO IL GRADED RA FILL 2. <br /> ' ° <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS o 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. yj <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a ^p-� <br /> NEEDED. z <br /> o � ) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. C <br /> ... NDIT10—N -F PERMIT: Vl <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 431- <br /> 2.2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. RE GRADING CU TING 0AND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> ING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> 4. NO STRUCTURES, INCLUD <br /> i <br /> SET CK A. A v m m % m <br /> 5. ly �b m. < v ° N N o 53 <br /> 00 10 <br /> N N O <br /> 6. /000 o ? EQ rn <br /> 7. d5 2 A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ° C <br /> knowledge and belief it is true, correct and comple in ane. ckaccompany ng schedule)and I further declare that Inowledge that I am responsible for the detail and crecognize fD m C <br /> all information contained in this application(including y <br /> that this information <br /> I am ept providing <br /> i I ability be <br /> relied <br /> may be aythe Countresult of the Countyy of eof Burnett relying determining <br /> onr this informeation ther to <br /> @ G <br /> sue a permit. I f o: <br /> providing in this application. I agree to permit county officials charged with administering county ordinances a other m <br /> authorized person to have acc ss to the ove de cribed premises at any reasonable time for the purpose inspection. <br /> SIGN HERE (d te,� <br /> (signatu of o r bui g t o <br /> ti <br /> <A A to di di'A <br /> N Nr71NN(n (T <br /> ZONING ADMINISTRATOR u, y o u rn o 0 <br /> 0000000 <br /> TOWNS IP PERMITS MAY BE REQUIRED <br />