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Office of Zoning 9 Administrator o 0 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 3 <br /> APPLICATION FOR LAND USE PERMITS N 0, <br /> N <br /> C <br /> N <br /> d <br /> <,, / TELEPHONE7 --3a2_ o yc W' <br /> OWNER QG ( �I 7Q SAID/ CSP <br /> / O <br /> HOME ADDRESS IC lV e d/�'r/L 0 <br /> EMERGENCY/FIRE NUMBER <br /> ROAD NAME d : 1 0 <br /> �� 3 a � -3� -i� ► CD <br /> N <br /> LEGAL DESCRIPTION(see tax receipt) e <br /> DWELLING/BUILDING ® GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ <br /> a <br /> TYPE OF PERMIT(S): S. <br /> FILLING/GRADING CAMP�NGUNIT ❑ SUBDIVISIONS ^ � o <br /> STRUCTURE/ADDITION USE: N <br /> (Home/Cabin;t,ofrlmercial Business; Bedroom; Deck;e[c.) <br /> C <br /> BUILDING CONTRACTOR rf- <br /> v <br /> m <br /> 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 6'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR on O <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> C <br /> n a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 5 o Z <br /> C7 m � <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m ;; <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C o <br /> y <br /> NORTH(N). TO m �v <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) ) <br /> CENTERLINE OF ROAD,(C)BUILDINGS)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF ` c <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 all Q <br /> BUILDINGS,ROADS,LAKE, LOT LINES. I o <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED RA FILLED. o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR,ETC.,THE PLANS O O <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION M7A BE DONFJl1�l j�N E <br /> NEEDED. / tP �� '/ l/� ' 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT1 <br /> ISSUANCE. <br /> ING OF TREES AND ALONG <br /> ALTERATIONS <br /> 2. REMOVAL OR 3. NO GRADING OR SHORELAND A TERA IONS ARE I ALLOWEDON IS RESTUNLESS SPECALLY CALLRY LINE. G <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLO ED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. V�/� t^ ! � A n m m go m <br /> N C O O a <br /> CD< vnmmo'- z <br /> 6. 4JEP ;, o 'z <br /> SPA)AA•' b� Swr-D _ e -#114-5ec 1 _ : m <br /> 7. � G�Sci A <br /> b me and bes f,tny <br /> I declare that this plication (including any accompanying schedule) has been a >py detail a d acc r ay/of o. <br /> knowledge and belief it is true,correctlication(int complete. I <br /> acknowledge that I am <br /> ng schedule) nd I r 66' that I r cT to i - <br /> O : Uzi m <br /> all information contained in this app g y ?Tet <br /> �r to is- m <br /> /� G) O <br /> A� o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin }moi in <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying orl`tihis info mation I he <br /> providing in this application. I agree to permit county officials charged with administering coam <br /> unty ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> >7 m 9- /8 ✓ <br /> a 000 <br /> SIGN HERE (date) <br /> (signature of er or building con to <br /> 4049��69J <br /> ZONING ADM[ ISTRATOR N N cn N N v,01cn f,,, ornlnoo <br /> 0000000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />