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Burnett County7410 County Road K N . 1 2 it m b <br /> ty 0 0 , Sen, WI 54872 Office of Zoning Administra or <br /> APPLICATION FOR LAND USE PERMITS a <br /> H <br /> 0 <br /> OWNER ' TELEPHONE <br /> Nicy a iS- 3 3o a <br /> n <br /> MAILING ADDRESS `^ ////1111 <br /> PROPERTY ADDRESS / 6me56 rq D e A ovee � o J <br /> LEGAL DESCRIPTION 6 /V /' / �0R7 n'0 g e/ � ° C> <br /> SINGLE FAMILY DWELLING ❑ GARAGE/ACCESSORY STRUCTU E�(( ADDITION ❑ STAIR ❑ <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAM//PING UNIT ❑ (,BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK <br /> STRUCTURE/ADDITION USE: <br /> ,(Home/Cabin; Commercial usineess; Bedroom; Deck; etc.) o <br /> BUILDING CONTRACTOR: e/Y/1 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 'h X11 SHEET OF RAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLNNS <br /> WILL BE RETURNED. O <br /> %d < <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) � e <br /> y 6 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE S� OWN OR DRAWN TO SCALE. M d <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BL ILDINGS/STRUCTURES (EB)AND ALL NEW L" <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, F ORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDINGS)TO ALL LOT LINES, (B) BUILDIN (S) n <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK OGl ,�30 <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND (D) LOT DIMENSIONS. N <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TAN K(ST)AND DRAINFIELD (DF),AND ALL DISTAN ES a, a <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. w' _ <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. (If.J, o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITEF, ENGINEER, BUILDER, CONTRACTOR, ETC.,T E E <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER, <br /> G� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKEq SO AN ONSITE VERIFICATION MY BE DONE WH=N <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> r z T <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. p O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION RESTRICTED ALONG SHORELINE. r7 i <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE AL WED UNLESS SPECIFICALLY PERMITTED. !n r <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW F R PRIVATE RESIDENTIAL GARAGE/STORAGE OP LY. <br /> NOT TO BE USED FOR HUMAN HABITATION. F <br /> ^ ry� a�moaoro <br /> � � aF <br /> 7. Ir 9i <br /> I declare that this application(Including any accompanying schedule)hi s been examined by me and to the best of my knowledge m C <br /> y <br /> and belief it Is true,correct and complete. I acknowledge that I am res onsible for the detail and accuracy of all Information n o <br /> contained In this application(Including any accompanying schedule)an I further declare that I recognize that this Information I <br /> am providing will be relied upon by the County of Burnett Wisconsin In i etermIning whether to Issue a permit. I further accept all c N 8 N$ <br /> liability that may be a result of the County of Burnett relying on this Inf rmatlon I am providing In this application. I agree to _ n <br /> permit county officials charged with administrating county ordinances oi other authorized person to have access to the above- c 9 n <br /> described premises at any reasonabl time fo the purpose of Inspectia . <br /> OWNER'S SIGNATURE <br /> (date) rn 6 a R <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MA, BE REQUIRED RRtt II{���� Co , <br /> THIS PERMIT SHALL EXPIRE ONE YE R FROM DATE OF ISSL WNI w <br /> ONIfVG <br /> I �im1 � v Ie -I er " Ie(I 4�30—Dr-) <br />