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CANS <br /> Burnett County 7aIAPPuR�TION FORLTLANDSUSE PERMITSIngAaminlstratcr a e <br /> OWNER NO(/rn f(,. - orr/ne BVW] Gl, TELEPHONE <br /> i <br /> ,/ �, <br /> MAILINGADDRESS 5� �� Ma✓J , L �J'L6yid Dk H� m� 55110 <br /> n /2 <br /> PROPERTY ADDRESS <br /> r LL < <br /> o <br /> LEGAL DESCRIPTION I' <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK❑ GARAGE/ACCESSORY STRUCTURE <br /> 5 <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO O STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ s b <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE 0 s <br /> STRUCTURE/ADDITION USE: <br /> o � <br /> (Home/Cabin; mmercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> 3 <br /> PLANS <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT C _ <br /> e c <br /> WILL BE RETURNED. "� ^ <br /> 'n d <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) ea C <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW 9 <br /> BUILDINGSISTRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH(N). o ^ <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B)BUILDING(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK o, O <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD (DF), AND ALL DISTANCES N O <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE ; W <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN -1 I <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: , _S� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. N <br /> A _ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. S <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER O <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. - E <br /> 6. y+rbtCj-iL✓Z ✓YML(j+ 5 +YOM `"� _?"�,i-,C toc" <br /> z7da000 aoro <br /> 7. <br /> w Z e n n n Z' <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my ? a. <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all A m > > N > <br /> information contained In this application(Including any accompanying schedule)and I further declare that I recognize that this . y <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I v a? ?��+ T ro <br /> further accept all liability that may be a result of the County of Bumex retying on this Information 1 am providing In this Fr c �+„�^, 8 0 '.. <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have c m o g: Di <br /> access to the above-described premises at any reasonable <br /> eason Iblee time for the purpose of Inspection. // / L� m w m'n `�w o"' > <br /> L. V A / J/ / co n agF'oc g ,� <br /> UO O' yy'cmn w ++ � <br /> OWNER'S SIGNATURE /./rte-----��}�--- (date)7 Q 'o <br /> V I f7� <br /> ZONING ADMINISTRATOR <br /> 0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE U 8 0 0 o g <br /> i�-6-0S <br />