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u <br /> Burnett County 7410 county Road K, No. 102,APPLICATION FOR Len, WI 54872 office of AND Ing Administrator <br /> LAND USE PERMITS l <br /> OWNERo55 II IOA(� TELEPHONE'715 oC `•J ��Q7y — <br /> 7777���I t ( <br /> r <br /> O <br /> MAILING ADDRESS <br /> , <br /> Fyy <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION ''Gk/K3- L O{ =;� r/ /-Ur�O Z-yO.'�6.�7..-S �S�tnU GIJ r' O <br /> I r <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE <br /> I = <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT ❑ <br /> r _ <br /> COMMERCIAL BUILDING C COMMERCIAL ADDITION ❑ COKMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: J��o �� J <br /> (Home/Cabin; Commercial Business; Bedroom; Deck, etc.) J <br /> !TQ /Ji <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1hX11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL 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/STRUCTURES (EB) AND ALL NEW o <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, JL <br /> AND INDICATE NORTH (N). a c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO LD GRADED OR FILLED. ^ \ <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE O <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. !V <br /> J <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN r �fJ IQ <br /> NEEDED. ty' <br /> CP i_ C �I\ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: _ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. p z �. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. I — C <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 J <br /> SETBACK AREA. U <br /> ' ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. o <br /> NOT TO BE USED FOR HUM/AN HABITATION. G <br /> 6. <br /> N <br /> 7. - N <br /> I declare that this application(Including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief it is We,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of all <br /> Information contained in this application(including any accompanying schedule)and I further declare that I recognize that this <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a pennit. I I <br /> further accept all liability that may he a result of the County of Burnett relying on this information I am providing in this <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have ! c _.W n <br /> access to the above-described premises at any reasonable time for the purpose of inspection. 1 - ,F = _ _ <br /> Fi <br /> OWNER'S SIGNATURE <br /> (date) < rn <br /> "1 _ C n <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ' <br />