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0-h�op <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator 3 <br /> APPLICATION FOR LAND USE PERMITS N <br /> CL <br /> ,,AA �^ TELEPHONE <br /> OWNER Cgsa> 7c931C <br /> O�tK + /V Ia+ Y )'eK Z) <br /> reXC` lt) <br /> HOME ADDRESS 'Sy 71 Q d 0. <br /> yDN rQp <br /> jy C� ROAD NAME C Long Lake <br /> EMERGENCY/FIRE NUMBER y <br /> L Nag <br /> 7/ Q� Laf S M <br /> LEGAL DESCRIPTION(see tax receipt) �0I 3 CSM Y 7 1 a V 0 <br /> N o <br /> DWELLING/BUILDING ElGARAGE/ACCESSORY STRUCTURE ADDITION PRIVY <br /> c � <br /> a <br /> TYPE OF PERMIT(S): <. <br /> FILLING/GRADING ElCAMPING UNIT ❑ SUBDIVISION LA. <br /> f a©/ o <br /> a <br /> STRUCTURE/ADDITION USE: V' ~A e-- ay X <br /> (Home/Cabin; Commercial Business; Bedroom;Deck; etc.) <br /> molt.. <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> 3 <br /> T (� <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8'/:X 11 SHEET OF PAPER. ANY INCOMPLETE ^h <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ;a m <br /> O `m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <br /> ('y <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m `? <br /> C o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE TO m 3 <br /> NORTH(N). p <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF oz <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> IC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPT <br /> BUILDINGS,ROADS,LAKE,LOT LINES. c <br /> S. 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 0 1 <br /> MUST BE SIGNED AND DATED BY THE OWNER. g <br /> WHEN <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE a <br /> NEEDED. <br /> o O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT T <br /> ISSUANCE. rrJ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY O <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. (.(�(� A or, o o m <br /> 5. � 2—D '- vaMmo ' 3 <br /> -o : <br /> co 6' t o N isi A <br /> _ rn : m <br /> 7. <br /> I declare that this application (including any accompanying schedule) has been examined o me and to the best of my G) C <br /> m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m <br /> 47: O <br /> all information contained in this application(including anyaccompanying <br /> Count BurnettuWis Wisconsin n determin ng whether90 is- o <br /> that this information I am providing will be relied upon by tY �: m <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. m <br /> SIGN HERE (date) <br /> (sign a of owner or building contr tor) <br /> Oil <br /> .. to to cnwww <br /> ZONING ADMINISTRATOR N N N N P P <br /> ino , 00 <br /> 000005 <br /> OWNSHIP PERMITS MAY BE REQUIRED <br />