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i 9 <br /> Bu nett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> TELEPHONE <br /> OWNER Ogp<c- ��� . (D7 Oy rL <br /> MAILING ADDRESS sO/ry A IZ p£/`J z 5 <br /> PROPERTYADDRESS 6177!/ 3 I Cy (Zf] WTSS /�/Z-/ W / S Z S <br /> LEGAL DESCRIPTION LOT/ �.5/-j V(O l 1'7q &00, <br /> TYPE OF PERNMS): SINGLE-FAMILY DWELLING❑ ADDITION I7 DECK ❑ GARAGE/ACCESSORY STRUCTURW <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO O STAIRS❑ FILLING/GRADING O CAMPING UNIT O <br /> COMMERCIAL BUILDING❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE Cl <br /> STRUCTURE/ADDITION USE: ¢ O c <br /> (Home/CeDin; Comms lel Bust s; Bedroom�;/Deck; etc.) ��.(,r <br /> BUILDING CONTRACTOR: I Z O — C vt, /— I��Ovyyr/c'V O <br /> 1115- X33 -063q 3 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 W X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PIANS C o <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AREAL 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 m <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, Q e <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S) g p <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK se J�Uj <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 k 4 <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. on <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 g <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. (IBJ 3 <br /> NOTE: BUILDING(STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> O <br /> THIS PERMIT IS SUBIER TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. O Z <br /> 2, REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHOREUIND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. O <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. 0 <br /> 7. AOnli <br /> RR � xoi <br /> I declare that this application (including any a¢ameanying schedule)has been examined by me and to the beat of my 3 Q 3 d. Iu <br /> knowMdga and MIM tt is erva,mrtect and compNte. 1 acknowledge that I am rosponsibk hr the detail and accuraq of all . ^G <br /> information contained In this application Uhn luding any accompanying schedule)and I further declare that I recognize that this E $$ N r3 <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to laws a permit. I 5 w 5w <br /> further accept all liability that may M a result of the county of BumeB relying an this information Ism providing In this s O g isY g f3 <br /> appllcaton. I agree to"MR county oKrcislacharged with administrating county ordinances or other authorized Waco to have ®® .2 <br /> access to the above-described premises et n reasonable term for the purpose of inspection. p C g pU <br /> OWNERS SIGNATURE -s`fG At"", y yR ry opn <br /> MUT <br /> ZONING ADMINISTRATOR it c� C: <br /> : s g <br /> WNSHIP PERMUS MAY BE REQUIRED OCT 18 2013 s #E <br /> THTC PFRMTT CHAI I FYPTOFTINF YFAR FPf1M IYATF nF TGCI Itp VANETTCOUN <br /> ZONING <br />