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r ett County 7410 Co ty Road K No 102 Siren WI 54872 Office of Zan- g Adm i t ator� — <br /> APPLIZATIDW-FOR LAND USE PERMITS— -_ — <br /> OWNER A / / TELEPHONE ` <br /> .�)0 of lac% a17 3461-a y/o ff <br /> MAILING ADDRESS Aer\ tT I � ( )� �C�O�� <br /> I I <br /> PROPERTY ADDRESS 3O (S !!' Ve/N —krINCO �� Ll' �1 <br /> / J ! 2 <br /> LEGAL DESCRIPTION dIJ_L�N� ncire, <br /> TYPE OF PERMITS): SINGLE-FAMLLY DWELLING 0 ADDITION P--DECK❑ GARAGE/ACCESSORY STRUC UREX L <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT❑ I <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 �p <br /> STRUCTURE/ADDITION USE: ,�>M< � (n�i�' 92"C E>i' <br /> (Home/Cabin; Co meroal Bosnh , Bedroom; Deck]etc.) fr1�I� <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yz%11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) a' <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 <br /> BUILDINGS/STRUCTURES(NE), INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, _ <br /> AND INDICATE NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) u <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK g I <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 BE GRADED OR FILLED. ,I <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. %y <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. — ;1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: t { <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br />-- 2. REMOVAL OR CUTTING OF TREES AND VEGETATION 15 RESTRICTED ALONG SHORELINE.' <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 <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. l <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> = p <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my f Z6 <br /> Knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all _ — _ <br /> information contained in this application(including any accompanying schedule)and IfurtherdeClare that i recognize that this E = i �_ i'F, <br /> informatign I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit.'I S <br /> furtheraccept all liabilitychat may be a resultofthe County of Burnett relying on this information I am providing in this S <br /> application. Iagreetopermit myoIn I charged with adminiAmti"CountyoMinanceroroMerauthorizedpersonto r <br /> have access M the above-descrdfy..�ffn mires reasa foie time for the purpose of Inspection, x o > �4Nn <br /> OWNER'S SIGNATURE — <br /> (date) <br /> ZONING ADMINISTRATOR -1 <br /> TOWNSHIP PERMITS MAY BE REQUIRED - <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />