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en, WI <br /> Burnett County 7410 <br /> 41 APPLICATION FORITLANDSUSE PERMITSZoning Admin)strat r a <br /> OWNER +. i i _ I,�. I TELEPHONE a_�jd -7 7 ly <br /> V C <br /> MAILING ADDRESS e. 4 <br /> fit'. La Ke k- <br /> PROPERTY ADDRESS �, �+ t <br /> C <br /> ,n <br /> LEGAL DESCRIPTION Gs y, t A <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTURE I>i ADDITION U STAIR ❑ <br /> TYPE OF PERMIT(S): p ^o <br /> FILLING/GRADING 11CAMPING UNIT ElBUNKHOUSE Ll59.692(1V)GAZEBO ❑ DECK <br /> Coot-a Z <br /> STRUCTURE/ADDITION USE: <br /> 0 <br /> (11Homel/Cabin, Commercial Business; Bedroom; Deck; etc.) rr <br /> BUILDING CONTRACTOR: <br /> r <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT P NS C <br /> WILL BE RETURNED. C c c <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> rMO <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 s <br /> BUILDINGS/STRUCTURES (NE), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, to <br /> AND INDICATE NORTH (N). '•J n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDI G(S) c <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK V�jf <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. 1 <br /> 4. SHOW THE LOCATION OF THE WELL (W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTA CES c` ` <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. 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., HE _ <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 W EN C S <br /> NEEDED. ^ <br /> d <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Z � O <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. G IJ <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 I ' <br /> SETBACK AREA. I <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE NLY. W <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. D 0 w o a o <br /> n Nc F rc . 77 <br /> 7. x T—. <br /> 3 7r .r <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my know edge <br /> and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information <br /> contained in this application(including any accompanying schedule)and I further declare that I recognize that this informatl n I <br /> am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I further acc pt all "c Cy, ti <br /> liability that may be a result of the County of Burnett relying on this information I am providing In this application. I agree <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the abov - a <br /> described premises at any reasonnab�tinn for the purpose of Inspection. 2 <br /> OWNER'S SIGNATURE ' D a <br /> I ( ate) rn <br /> ZONING ADMINISTRATOR \-/ 'T�-�' /M' Ra `(` ' -ry <br /> aO <br /> IRED <br /> TOWNSHIP.. ERMI��MAI� R�EQUT'�f rtp //6LLbG�e <br /> THIS PERMIT SHALL(EXPIRE ONE YEAR FROM DATE OF ISSUANCE �7 <br /> purn(,� <br />