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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS . �n <br /> o <br /> J <br /> OWNER K TN ERINE gZj4Eot91q jPeffr <br /> A©PDTELEPHONE �� <br /> OC.MAILINGADDRESS 150q DOCK 1R�G R sp©0/UE W= S 1 30 94,/v <br /> PROPERTY ADDRESS 10 Ly O D CK k4 KE R D p <br /> LEGAL DESCRIPTION(see tax receipt) SW V4 Ot=S E fly ©r S€C /4 T3 9 R Q <br /> I <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ rn ° <br /> TYPE OF PERMIT(S): ` <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ o. G <br /> N <br /> STRUCTURE/ADDITION USE: /?_ X 10' M ETR& CR R PD RT 0 (((eee <br /> (Home/Cabin, Commercial Business, Bedroom; Deck; etc.) rn <br /> BUILDING CONTRACTOR: O U)N E R <br /> m <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. p J) <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 n 1 <br /> T 6 Z <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 <br /> NORTH(N). CD 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. ° <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. O <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 j. o <br /> MUST BE SIGNED AND DATED BY THE OWNER. ° F I <br /> O <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o W <br /> M. <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o ` 0 <br /> Z <br /> CONDITIONS OF PERMIT: v Gl W <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT O <br /> ISSUANCE. W C <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. <br /> 5. <br /> CD C W 0 oaom <br /> 6. 0 ,'c 3 a m Ox <br /> O m C y N 0 3 <br /> 7. Z C N N O O <br /> ° D T� <br /> U, m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of myc O <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m' ° <br /> all information contained in this application (including any accompanying schedule)and I further declare that I recognize m m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- m rn : <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 m o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized perso 4 ave access to the pbove described 4emises at any reasonable time for the purpose of inspection. T a <br /> > : <br /> E» a <br /> SIGN HERE <br /> (sign of ow ne building contr ctor) -/� (date) <br /> ZONING ADMINIS11A1 01. 169 <br /> ` <br /> 97 4661-ce I(ar O N W W N O <br /> 60141 8ar'j TOWNSHIP ERMITS MAY BE REQUIRED O (TON V N O <br /> /d-3/-01 as 90l s TIS PERMITd9HALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />