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OCT-16-2007 10:36 DIVIDEND LUMBER 1 715 866 5320 P.02iO3 <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator W <br /> APPLICATION FOR LAND USE PERMITS a _ <br /> OWNERC IIA / ?/,T 7 TELEPHONE <br /> ( 7 <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS <br /> LEGALOESCRIPTION c7 <br /> TYPE OF PERMn 3O: SINGLE FAMILY DWELLING 0 GARAGE/ACCESSORY STRUCTURE 0 ADDITION 0 STAIRS 0 (� <br /> FILLING/G ING 0 CAMPING UNIT 0 BUNKHOUSE 59.692(IV)GAZEB0 0 DECK 0 <br /> STRUCTURE/ADDITION USE: '" YfXL,52 / ./CLcAQ Z .�. <br /> (Hon m; Commercial Buslness; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: �/G-7/./A"& ) rS pG„/7,e - C� <br /> O <br /> A PLOT PLAN MUST BE PROVIDED ON AN B Ya X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED, <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) 0; 2. ll� sz� <br /> I. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. tai <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW C A <br /> BUILDINGS/STRUCTURES (NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N)- <br /> 3, SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDINGS) c <br /> TO CENTERLINE OF ROAD,(C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK ,o <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS, N <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES S w <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES, 9' <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. e <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR,ETC.,THE Q <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. A <br /> H <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN O <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: C <br /> 1, DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. et <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER C <br /> SETBACK AREA, <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION, <br /> 6. <br /> gb > roa �d <br /> 7. 1• c a G 3 <br /> I declare that this appllcvNM(inducting any accompanying schedule)has been examined by me and to the Cent W my knowledge 9 2 �; m Pand belief R Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information ' a »: ' <br /> contained In this application(includNg any accompanying sdlad ile)and I further declare that I recognize that this Information I V yy <br /> am providing will be railed upon by the County of Burnett Wieconaln M determining whether OD L9we a permit. I further accept all a o o of <br /> IIabIIRy that may be a result of the County of eu rd ng on this Information I am ro <br /> TRY yl providing h Mk permit. I f t spree e n IR <br /> V; <br /> county officials charged with administrating mty ordinances or other authorized person to have access to the above- e' u <br /> described premises at any reasonable time for th purpose of Inspection. to w <br /> OWNERS SIGNATU <br /> (date) r ' e c c's1 <br /> R�U <br /> ZONING ADMINISTRATO Q.L,R. N <br /> C7 <br /> TOWNSHIPEXPIRE MAY BE REQUIRED <br /> THIS PERMIT SHALLNE YEAR FROM DATE OF ISSUANCE S u o <br /> fm�f lei ��r�ked top hclkor�hWoods Cctr,Pe,-)' -, <br />