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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator v0 Z <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> UT 0 <br /> OWNER Dong]-ti'L h. and Be3Y'bc1Y'S E. L8J•1r8 TELEPHONE (71.5) 656-3050 p ,� <br /> CD <br /> HOME ADDRESS 6648 HaydQ& Lake Road DaRb lry, WI 5030 <br /> �r <br /> EMERGENCY/FIRE NUMBER 6648 ROAD NAME Hay" LSke I <br /> 3-2 V 353 P 178 450/310 SO 3/M R16W Acres U` <br /> LEGAL DESCRIPTION(see tax receiptpp�-16- ICG03-0 010 <br /> 2��077PC1. 3s Gov Lot: 1 Ex CSM V 1 U <br /> I <br /> DWELLING/BUILti &GAR (:?E55012Y STRUCTUREC ADDITION 1:1 PRIVY ❑ (n <br /> TYPE OF PERMIT(S): `v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ °" <br /> STRUCTURE/ADDITION USE: H0■Q Q ° <br /> (Home/Cabin; Com ercial Business; Bedroom; Deck; etc.) <br /> v <br /> BUILDING CONTRACTOR: CD <br /> w <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> .ZI y <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) OIn <br /> o <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(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). W `3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <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 ) <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> O � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. W <br /> 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> 0 <br /> CONDITIONS OF PERMIT: ) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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. <br /> 5. <br /> 6. m nm ° am <br /> mCy o' � 3 <br /> n ° o <br /> 7. o : T� m <br /> - � : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 0 p <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of a A <br /> all information contained in this application(including an accompanyingschedule and I further declare that I recognize PP ( 9 Y ) 9 fD p <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 1 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. CDT <br /> m : <br /> CD <br /> SIGN HERE 8-1$01 <br /> (sign�f own r or building contractor) (date) <br /> ZONING ADMINISTRATOR U 4 <br /> 1 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 1.S-6/1--t3- <br />