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6urnett County 7410 Co. Rd. K, No. 1102, )iron, IMI 54872 Office of Zoning Administrator TCl �L <br /> APPLICATION FOR LAINIQ USE PERMITS' <br /> ' �6 _ l_ �'t ,fin •_ �: <br /> OWNER 'eyc'tc -J EL-EPHONE <br /> J <br /> HOME ADDRESS .�oCcK�pGt G,�!l 1 <br /> EMERGENCY/FIRE NUMBER ROAD INAME CiLCIX60'ell <br /> J7'Li .)�Z o 3 :3 <�-Sd + <= ?;f—;—,— <br /> LEGAL DESCRIPTION see tax receipt) _-__,----�� --- --�— ---------- <br /> cc <br /> DWELLING/BUILDING ElGARAGE/ACCEiSSORY STRUCTURE EI ADDITION PRIVY �� a <br /> TYPE OF PERMIT(S): Cn <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION a � J <br /> STRUCTURE/ADDITION USE: fa-{ j- <br /> (Ronne/Cabin; Commercial Business; I3edroonn; C)eck;etc.) cn <br /> BUILDING CONTRACTOR: - ' .r _" " ____-__� �l / i @ (�� '• �� J ` <br /> A PLOT FLAN MUST BE PROVIDED ON,A'T LEAST AN 6'/2 X 11 SHEET OF P R. ANAPEY7-77 11 LIETE OR c3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> T1 :: �• a <br /> DIRECTIONS FOR PLOT PLAN DRAWING:. (AERIAL OR TOP VIEW) C, io C� C'{ <br /> TI ti / <br /> TI I 2. 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHVVIJ IG OR DRAWN TO SCALE f7i <br /> BUIL-DIINGS(NIE3)�41ND INDICATE eu <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB),AND ALL NEWrn <br /> NORTH(N). C (� <br /> 3. SHOW DIMENSIONS IN FEET OF THEFOLLOWING: (A)BUILDING(S)TO ALL LOT ILINES, (B)BUILDING(S)TO ran `�/ -3 <br /> CENTERLINE OF ROAD,(C)BUILDIING(S) MEASUREMENT TO THE ORDINARY HIGH V!/Al'ER MARK(OHWN1)OF: <br /> �. i) <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. (r o <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELID(DF),AND ALL DISTANCES TO <br /> BUILDINGS, ROADS,LAKE, LOT L.INIES. r^� <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. �� np (�> <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE PLANS �y <br /> MUST BE SIGNED AND DATED BY THE OWNEER. ,f�cQ a{ II <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SCAN ONSITE!VERIFICATION MAY BE--- DONE WHEN (n <br /> NEEDED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITION'S LISTED BELOW. 5)OC NDITI()NS OF PERMIT: �) �3 S <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REOUIRENIENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. i N",� ;. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Lu <br /> PERMITTED. ) <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE: REQUIRED WATER <br /> SETBACK AREA. (�) <br /> R7-o m r—_�c)ti C1-Cl <br /> �I M <br /> 6. '29 ii m� 9: fD. X-I <br /> 7. eC N 2 R <br /> _____________ j ' m ' rnI <br /> I declare that this application (including any accompanying schedule) has been exarWned by me and to the best of imy 0 <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> �: ie rti <br /> all information contained in this application (including any accompanyEng schedule)and I further declare that I recognize <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- G <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 ; aY <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or otlher m <br /> authorized person to have agoss to the above desc: `bed premises at ainy reasonable time for the purpose of inspection. <br /> -------------- ---- <br /> ai <br /> SIGN HERE E <br /> --- --------------------- . . . . i <br /> (signatu d-b ie Gr building contractor''—) (date) (� <br /> ZONING ADMINISTRATOR 14 <br /> ---- --- ) --'"—' ----- . . . . . <br /> --------------------------- . . <br /> O . .) <br /> TOWNSHIP I IERMITS� IMAM BEREQUIREDf� f= c) 0 0 0 <br />