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Ncc ry <br /> Burnell County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r- <br /> 0 <br /> N <br /> ��ff � { �7 C <br /> OWNER �/"G'+JC:'e — TELEPHONE / o. <br /> /'� p1 �I <br /> HOME ADDRESS � ' ��/ f�h� C'�lG �Cs�'CJ lC <br /> EMERGENCY/FIRE NUMBER ! > : ROAD NAME f > I <br /> I <br /> ,4 e r 3 f4 e?94 `-"lel` 9-e 12F5 <br /> T LEGAL DESCRIPTION(see tax receipt) /2 i� K,Sd t 4'.;Ai'g Zic �if�'A`1 7%C'1rCcDn <br /> 0.DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE 2 ADDITION ❑ PRIVY [:1 �`] mTYPE OF PERMIT(S): V a <br /> Cr <br /> FILLING/GRADING y❑ CAMPING UNITE] <br /> SUBDIVISION /❑ <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) ur <br /> ® 1 m <br /> BUILDING CONTRACTOR: rye r f�f L �MjT>r/ <br /> C <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR m 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> �I N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 o <br /> ,n o z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). 1 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO M <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. P <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. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. o e <br /> o � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHENq o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c Q <br /> CONDITIONS OF PERMIT: <br /> ( <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. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC., LLOWED WITHIN THE REQUIRED WATER <br /> SETBACKREA. <br /> 5. CL <br /> J <br /> S /1 1 <br /> 7. g/U 5.., o < ;a—En m <br /> I declare that this application (including any accomp schedfil�h s bee mined by me and to the best of my ij 10 <br /> knowledge and belief it is true, correct and complete. I a edge res !Ole for the detail and accuracy of n B <br /> all information contained in this application(including a n, edul nd I further declare that I recognize m m m <br /> that this information I am providing will be relied upon by f Burnett �onsin in determining whether to is- O <br /> sue a permit. I further accept all liability which may be a resu ty 9uFnett relying on this information I am m <br /> providing in this application. I agree to permit county officials c arged nistering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> M : <br /> CD <br /> SIGN HERE <br /> (sig ture o erar tractor) (date) <br /> ZONING ADMINISTRATOR OD ' ' ` ` ` 'r+ <br /> to Fn 4A v+w <br /> N N M N N V 01 <br /> fT N O V N O O <br /> T WNSHIP PERMITS MAY BE REQUIRED 0 0 0 0 0 0 0 <br /> 0000000 <br />