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Bumett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> !� P>y "163-24 1 -3w\\ <br /> OWNER r ��\QLpN TELEPHONE Iol2-945—S-2,06 <br /> MAILING ADDRESS Tao o�t\0.N ` ja V\{ biSC o v+'xN fj633`� <br /> 1 Ot r (� q LL p, <br /> PROPERTY ADDRESS 13643 Gtv�Rr �Ox+x} T�O�✓�J\/✓R-�s�r�('`�_ � 18 L2 n <br /> LEGAL DESCRIPTION l_pk S C.Sy. V 10 <br /> Z 2_1ii-17 <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING O ADDITION O DECK O GARAGE/ACCESSORY STRUCTURE Cl <br /> BUNKHOUSECI 59.692(l V)GAZEBO O STAIRS O FILLING/GRADING O CAMPING UNITb( <br /> COMMERCIAL BUILDING O COMMERCIAL ADDITION O COMMERCIAL ACCESSORY STRUCTURE O <br /> STRUCTURE/ADDITION USE: <br /> BUILDING CONTRACTOR: <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> _ r c <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'A X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS a _ <br /> WILL BE RETURNED. o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL ORTOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. _ m <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, 4 o <br /> AND INDICATE NORTH (N). V " JI Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) _ <br /> 4:7— <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENTS)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 GRAINFIELD(DF), AND ALL DISTANCES Q) Z iJ[ <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. O <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN ) <br /> NEEDED. <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. Pf) r] c <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. a x <br /> 3. NO GRADING OR SHOREIAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. L <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER IN <br /> — SETBACK AREA. Q <br /> 5, ACCESSORY 5TRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. 4 <br /> 6. � / � <br /> 7. N/�. / j/ SA Yn n . OYOS <br /> R 'n ' 333Kc' R <br /> 3332 = F <br /> I declare Nat this applkation(Indus ing any accompanying schedule)has been examined by me and to Me best of my 3 o j _ <br /> knowledge and Mid It tr true,correct and complete. 1 acknowledge that 1 am responsible for We detall and accuracy of all m="' � �? <br /> Information contained In this application(including MM <br /> udin9 any accompanying schedule)and 1 further dare at i recognize at this '� ` > <br /> Information I am providing will be relied upon by Me County of admen Wtscpnvn In determining whether to issue a permit 1 <br /> further accept all liability that may be a result of the County of Burnett relying on this information 1 am providing In this _ 4e N i.1n=T,'9 'o <br /> 'application. 1 agree to permit county olgclals charged win administrating county ordinanm or other aoMomed person to have n J o S P 588 - <br /> access to the above-described premises at any reasonable time for the purpose of Inspection. v,a I7 <br /> (a Io �13 > moo $$ ' . <br /> OWNER'S SIGNATU u�mn �y_ � <br /> (date) R <br /> e R <br /> ZONING ADMINIsrRAroRTOWNSHIPPE= Y BE REQUIRE �r�} M a <br /> RMITS <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE SSUANCE D — <br /> JUN 13 2013 <br /> BURNETTCOUNTY <br /> ZONING <br />