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Zoning Administrator �o <br /> Burnett county 741oAPPLICATION FOR ( 54872 Office of LAND USE PERMITS g 3. o <br /> N <br /> C <br /> TELEPHONE7/S-O6/_737'7 0 <br /> OWNER M G14kO�JKEL �2' N <br /> Aga ,� < <� La �65,�r <br /> s�`9 3 <br /> HOME ADDRESS <br /> 0 <br /> ROAD NAME Devtfs 0, Pd <br /> EMERGENCY/FIRE NUMBER Sw A) Elt N j E/0 <br /> P <br /> ��.rr7 30 , N S� oFS.30R t <br /> LEGAL DESCRIPTION(see tax receipt)5eY{-,2 TOWA 'rV �Q/�-�� <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ PRIVY ❑ <br /> Q <br /> TYPE OF PERMIT(S): <br /> a <br /> FILLING/GRADING 11CAMPING UNIT ❑ SUBDIVISION � , T. <br /> STRUCTUREIADDITION USE: <br /> SToRAG� I// ° P <br /> (Home/Cabin; Commercial Bushes dr om; Deck;etc.) m <br /> BUILDING CONTRACTOR: <br /> v <br /> m <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INCOMPLETE OR TO • <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. ;0 vN ^ <br /> n n C` <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) <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 /> C n <br /> rn <br /> NORTH(N). m <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF o <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <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. o <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.,THE PLANS �_ <br /> v = ) <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> ( p , <br /> STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE r <br /> NEEDED. <br /> Z <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. P 1 <br /> CONDITIONS OF PERMIT: /> <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT XJ <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 /> 'U 0`-( / <br /> m m ° cp a f m <br /> 5. ° <° � n nm A <br /> CD am m o E 3_ <br /> -° D o <br /> 6. <br /> M <br /> 7. <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my c <br /> knowledge and belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize . 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 apermit. I further accept all liability which may be a result of the County of Burnett relying on this information I am <br /> providing in this application. I agree to permit c u ty officials charged with administering county ordinances or other <br /> authorized pe n to have a ces the ve b d premises at any reasonable time for the purpose of inspection. - <br /> m <br /> SIGN HER b (date) <br /> (sign o ner or building contractor <br /> ZONING ADMINISTRATOR <br /> TO NSHIP PERMITS MAY BE REQUIRED OJ 'f 6 <br />