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9urnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -CD o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> y O <br /> N <br /> OWNERl Ir-,' / s i[ 1 0 <br /> aeTELEPHONE o <br /> HOME ADDRESS 31 o o Y /fid <br /> r m <br /> EMERGENCY/FIRE NUMBER o o Y ROAD NAME Red f�x *offa/ G W <br /> PCL Gov stir t S' /3� TY/ - /QIbW <br /> LEGAL DESCRIPTION(see tax receipt) m <br /> 0 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION PRIVY ❑ • <br /> TYPE OF PERMIT(S): c <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> ) �)c/ N <br /> STRUCTURE/ADDITION USE: > c Ir e r2 T� 1/ /b /a- 0 <br /> (UNRLeXabirf Commercial Business; Bedroom; Deck;etc.) rn <br /> BUILDING CONTRACTOR: <br /> w <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR m3 <br /> A�DIRECTIONSiFORPLOT <br /> EGIBL£fLOT PIANS WILL B -n <br /> O - ciO y <br /> PLAN DRAWING: (AERIAL ORTOP VIEW) O m [` <br /> -n n <br /> Z! Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> n <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. o <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. IN C <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS \ 0 w <br /> MUST BE SIGNED AND DATED BY THE OWNER. --I (� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN _ ( n <br /> NEEDED. <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q <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 /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER r <br /> ACK AREA <br /> 5. <br /> � �. o ' lu <br /> Mn m <br /> 6. Aze <br /> m a m lc' -•g 70 t ;; 111 0 q <br /> 7. Z . N �� ' M .0 <br /> o <br /> =a': m <br /> I declare that this application (including any accompanying schedVanng <br /> as been e y nd to the best of my 6 c p <br /> knowledge and belief it is true,correct and complete. I acknowledt I am sponse o Pti <br /> accuracy of � m C <br /> all information contained in this application(including an accom sc O:pp ( g y p )�n d l furt rt l recognize �m <br /> that this information I am providing will be relied upon by the County !!� urnet IsEo si m dethett4r to is- <br /> ft ' O <br /> sue a permit. I further accept all liability which may be a result of the�^ Burnett omation I am m <br /> providing in this application. 1 agree to permit county officials charged wisterin ounces or other mauthorized person to have access to the above described premises at any r I for the inspection. T <br /> : <br /> CD <br /> ,t' 40 : y <br /> SIGN HERE < 'VG -3 <br /> (signature o o r or uilding contractor (date) <br /> ZONING ADMINISTRATOR (3 <br /> N (TNNfT n, <br /> TOWNSHIP PERMITS MAY BE REQUIRED �� 0 0 0 0 0 <br />