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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator � o° o <br /> APPLICATION FOR LAND USE PERMITS . < <br /> r <br /> ,n o <br /> N <br /> C <br /> OWNER LO rr j n Order--,o n TELEPHONE "](y3 _624- - gC1(;3 _ O <br /> - m <br /> O <br /> MAILING ADDRESSF - --- —DCCS�j <br /> PROPERTYADDRESS 1_�p,Y1bL r�1 uDT n4-QJ <br /> pp Y <br /> LEGAL DESCRIPTION(see tax receipt) -r- LAO . K.-1-1 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION191 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ 5 <br /> 2 N <br /> & <br /> STRUCTURE/ADDITION USE: k7seirne..1)4 <br /> 0 <br /> 1 , (Holme/Cabin; Commercial Business; <br /> Loc.Bedroom; Deck; etc.) y m <br /> U I <br /> BUILDING CONTRACTOR: WI'LLtt..VlGf �ll�C,.Ln A ICC S-�T1 Y CLO n C <br /> br J <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81A X 11 SHEET OF PAPER. ANY INCOMPLETE O ,n 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O .. <br /> Dns ak e� 0 y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> T <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 yA a <br /> NORTH(N). 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING3 <br /> S)TO m J <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 1 <br /> BUILDINGS,ROADS, LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> f <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> ) <br /> O � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN ° <br /> NEEDED. "h <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o W <br /> CONDITIONS OF PERMIT: t <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT I <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 Q <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> m mmsri r�imoD. 0m <br /> m x3 ;D <br /> 6. <br /> Z C N N O 7 <br /> 7. o <br /> - � ` �: A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my cj � � <br /> knowledge and belief it is true, correct and complete. 1 acknowledge that 1 am responsible for the detail and accuracy of n 0 A <br /> all information contained In this application (including any accompanying schedule)and I further declare that I recognize _ N m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Information I am o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other ,o m <br /> authorized person to have access to ttip above described premises at any reasonable time for the purpose of inspection. <br /> T <br /> N d <br /> SIGN HERE �/jQ /2C <br /> (sig turre�off�ownerr building contractor) (date) <br /> ZONING ADMINISTRATOR 1 1 / 1 `L�-n�"Ivl� <br /> " <br /> � <br /> c, NN O (n WW w W NO <br /> OUONUtUO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL <br /> EXPIREONE YEA ANCE <br /> ptr( - 4- � 6 <br /> JA p <br />