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o <br /> Burnett County 7410 County Road Kr No. 102, Siren,WI 54572 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS a <br /> OWNER Nancy Wahl TELEPHONE 715-349- p <br /> MAILING ADDRESS PO Box 234 Webster WI 54893 <br /> PROPERTY ADDRESS 6096 State Rd 70 1 <br /> LEGAL DESCRIPTION Pds in Gov Lot 2 section 36 T 39 R16W(07-018-2-39-16-36-5 05-002-01100&012000) <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING 0 ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE X (.. <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT 0 w <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURED S' 1Z- <br /> STRUCTURE/ADDITION USE: Garaoe <br /> (Home/Cabin;Commercial Business; Bedroom; Deck,etc.) {I— 9 <br /> J <br /> BUILDING CONTRACTOR: Northland Builders Inc � OQ <br /> O � <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Va X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. .� <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AR1iAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, 1 a <br /> AND INDICATE NORTH(N). 9 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) o <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 5' J <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 din <br /> TO BUILDINGS, ROADS, LAKE,LOT LINES. <br /> S. 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 <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. C W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. i <br /> w <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. f° <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Z O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Q <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. E <br /> 7. > 0 0 0 0 n rn <br /> rn <br /> El c c <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge 3 e 8 o. P w <br /> and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information 8. pi L. E. a : : H <br /> contained in this application(Including any accompanying schedule)and I further declare that I recognize that this information I a E'> a m <br /> am providing will be relied upon by the County of eumett Wisconsin in determining whether to issue a permit. I further accept all 5 g -k - ; : !yy <br /> liability that may be a result of the County of aumett retying on this information I am providing in this application. I agree to o q° <br /> permit county oNcials charged with administrating county ordinances or other authorized person to have access to the above- <br /> described <br /> bove-desWbed premises at any reasonable time for the purpose of inspection. ii g in A <br /> >o85 <br /> $o <br /> OWNER'S SIGNATURE 020 > a <br /> ZONING ADMINISTRATOR '� Lo °= <br /> TOWNSHIP PERMITS MAY BE REQUIRED 00 <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE N <br /> Pe►'vri�;! j4e � �tcked u� by l)Orfhlaha( i8/Ail ,�rs l6 5-lo NQS " = 4 <br />