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0 County Road K, No. 102, <br /> en, WI <br /> Burnett County 741 APPLICATION FOR IrLAND SUSZ PE Ce of ITS Zoning Administrator o <br /> OWNER ��(] TELEPH j t^`', ,1 e <br /> MAILING ADDRESS <br /> PROPERTY ADDRESS��`L - - /(� � �_ l_ _ 1 1 �i a ' <br /> LEGAL DESCRIPTION �UC�7V` ��pC'�.���• �V J <br /> 0 Lnn � <br /> t l L m\f 1 IA.tA'V�tk - ° N <br /> �_ <br /> SINGLE FAMILY DWELLIN GARA E/ACCESSORY STRE 1-1ADDITION0 S RS -0 0_ <br /> TYPE OF PERMIT(S): � g- <br /> FILLING/GRADING 0 CAMPING UNIT 0 BUNKHOUSE 0 Q5�f�9.�692(1V)GAZEBO 0 DECKID <br /> STRUCTURE/ADDITION USE: A n _ I;ONvarrlvti��-lAY�ilt� -Nbly„•-� � <br /> (Home/CaL1,ig1; Com RtErcial/ � Busines3! BedrooYn; Deck; etc.) <br /> BUILDING CONTRACTOR <br /> k5 f Exlnr <br /> A PLOT PLAN MUST BE PROVIDED ON AN 81/2 X11 HEET OF PAPER. ANY INCOMPLETE OR ILXEGIBLE PLOT PLANS C Q <br /> WILL BE RETURNED. SQA Udn2n,e. V.k 9'36 r <br /> L -e <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> � a Q <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. r) i�—' d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW y .^o <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, m ro <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S) TO ALL LOT LINES, (B) BUILDING(S) n <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S) TO THE ORDINARY HIGH WATER MARK l <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. N15 <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF), AND ALL DISTANCES 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. t7 W c Q <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. Oq <br /> H i <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. V V <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: S C <br /> P <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. <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. <br /> 6. <br /> gyanmoa7. on rri <br /> e <br /> I declare that this appllcatlon(Including any aaompanying scftedule)has been examined by me and to the best of my knowledge <br /> and belief k Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information p <br /> contained In this appllcatlon(Including any aarompanying schedule)and I further declare that I recognize that this Information I d . <br /> am providing will be miled upon by the County of Burnett Wisconsin in de[ertnining whether to Issue a pertnit. I further accept all <br /> liability that may be a result of the County of Burnett relying on this Information I am providing in this application. I agree to n'o <br /> permit county offlclals charged with administrating county ordinances or other authorized person to have access to the above- o E <br /> described premises at any reasonable time for th urpose of I ctlon. _m n N s = Y <br /> oma O <br /> OWNER'S SIGNATURE �_ o; N o n Z <br /> (date) p g D d <br /> OCTp $ _ cac m <br /> ZONING ADMINISTRATOR OC1 ,; 2007 ,'�P`' o. : 71 <br /> o . <br /> c i i <br /> TOWNSHIP PERMITS MAY BE REQUIRED BURNETT COUNTY <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCIZONING y <br /> 4omzk j- 18*4e+- /ty�--d & abm Ovo hn�o /0-y-o-) o <br />