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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator -0 0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> N 0 <br /> N <br /> ,p C <br /> OWNER KAREN KO W CL I TELEPHONE �� 7 is <br /> MAILING ADDRESS a 67 L- , Xc, �Q g e �• LlJ .� 9J o <br /> rCD <br /> PROPERTY ADDRESS a yd 0- /?a/ A ) Orygo Air A n o <br /> sc iG -ie 3S5/yyi 9//.1-73 S/6 Tya /1/yZj <br /> LEGAL DESCRIPTION(see tax receipt) 1,`sp v2-Vo-8-4-0 D370D Lo T/ <br /> c►NAGL <br /> DWELLING/BUILDING GARE/ACCESSORY STRUCTURE ADD TIO fW 0 <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING X CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> e � <br /> STRUCTURE/ADDITIONQSE: its,y 0 <br /> Qzo (Home/Ca , Comrrvgrcral Bus ess;Bedroom, Deck;etc.) <br /> d <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN B'/:X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n (� <br /> O ^rte <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O � V <br /> n a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n -r <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 3 <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. N <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. <br /> 0 <br /> 41. <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a S <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o E <br /> CONDITIONS OF PERMIT: <br /> Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT W <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 <br /> SETBACK AREA. /�a l —�` ��j�� �� d ��/�„y�l�.I /��� <br /> s. !!! v�e1 C� � G' � d °r a f m <br /> �' 3 am X2 ; <br /> 5 m Cy 0 <br /> Z N O <br /> 7. n <br /> O T2 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my �j A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 0 : in <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m o 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 n� <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other o <br /> authorized person to ave access to the above described premises at any reasonable time for the purpose of inspection. m m <br /> o : <br /> ` l m m <br /> SIGN HERE <br /> n : <br /> ( ' tur of <br /> own or i ing contractor) /(di/ajte) <br /> ZONING ADMINISTRATOR6969 <br /> EN(AT fA f(NAT E(NAT 0O O <br /> 0 <br /> TWNHIPPOSERMITS NO <br /> MAY BE REQUIRED <br /> f(P� <br />