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0 vc"/iLr <br /> Z <br /> Office of Zoning Administrator o <br /> Burnett County 7410 Co. Rd.K, No. 102, Siren,W154872 3 <br /> APPLICATION FOR LAND USE PERMITS N <br /> TELEPHONE 1,6- <br /> OWNER Iq <br /> f <br /> .ry 'I <br /> HOME ADDRESS a / 7� 5 yv Dc _ °r <br /> ROADNAME TO /µ S 6�� <br /> EMERGENCY/FIRE NUMBER EnCD ' <br /> L �a <br /> � N <br /> LEGAL DESCRIPTION(see tax receipt) PRIVY ❑ c ' <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE KJ ADDITION ❑ a <br /> TYPE OF PERMIT(S): FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ o <br /> SK <br /> �a`k _ — <br /> v <br /> STRUCTURE/ADDITION USE: (H,,om``e/Cabin; Commercial Business; Bedroom; Deck;etc. � <br /> 0W S <br /> v <br /> BUILDING CONTRACTOR: m <br /> T 3. <br /> o <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE 0 N <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. Oa <br /> O <br /> Z <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) T n Z <br /> rn l <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m v <br /> BUILDING(S)TO <br /> NORTH(N). THEWATER \ o <br /> 3. SHOW DIMENSIONS IN FE BUIL NG(S)MEASUREMENT TO THE(ORDINARY HIGH TO ALL LOT LINES, MARK(OHWM)OF <br /> CENTERLINE OF ROAD,( ) <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ` N <br /> PTIC TANK(ST)AND DRp INFIELD(DF),AND ALL DISTANCES TO <br /> 4. SHOW THE LOCATION OF THE WELL(W),SE _a <br /> BUILDINGS,ROADS,LAKE,LOT LINES. O l <br /> CONTRACTOR,ETC.,THE PLANS 5 o <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO IL GRADED OR FI <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER, o ? <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Z <br /> NEEDED. P <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: t <br /> THIN 60 DAYS OF PERMIT <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WIC <br /> ISSUANCE. OF TREES AND o. 1 C <br /> 2. REMOVAL OR 3. NO GRADING OR CUTTING <br /> IINGELAND ALTERATIONS ARE I AILLOWEDT UNLESS SPECIFICALLY <br /> ALONG LIN . <br /> HOR <br /> PERMITTED. ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, <br /> SETBACK AR A. '��a p v a m o O ' o <br /> G N M <br /> ° 4 (p <br /> � � -0CCID <br /> a <br /> 7. <br /> I declare that this application (including any accompanying schedule) has been examined by <br /> me and to the best of my O 2 <br /> the <br /> (including any accompanying schedule)and I further declare that <br /> „eYher9o'se <br /> knowledge and belief it is true,correctapplication(incpleteg I acknowledge that I am resPon l f in det amini g d accuracy recognize <br /> �* �c <br /> all information contained in this ing will be relied upon by the County of Burnett Wisconsin <br /> providing of Burnett relying on this information I am <br /> that this information I amp be a result of the County a <br /> sue a permit. I further accept all liability which may <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of i(spection. � <br /> (date) <br /> SIGN HERE (signature of ow r or uilding contractor) , <br /> ZONING ADMINISTRATOR l 13�o G <br /> TOWNSHIP PERMITS MAY BE REQUIREDf�— <br />