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I <br /> Burnett County 7410 County Road K, No. 102, Sir n, WI 54872 Office of Zoning Administrator R o <br /> APPLICATION FOR L�4ND USE PERMITS a <br /> T 0 <br /> OWNER //�rls� /SOn TELEPHONEq 1 <br /> L 7 n <br /> MAILINGADDRESS a(�a�C/ lNd(Qo� � n ,ps � J OC✓�: <br /> PROPERTY ADDRESS <br /> VG( <br /> LEGAL DESCRIPTION p <br /> SINGLE FAMILY DWELLING O GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ S AIRS ❑ o p <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT BUNKHOUSE Cl 59.692(1V)GAZEBO ❑ D CK ❑ _ <br /> STRUCTURE/ADDITION USE: S ralnZ26Cz 9- <br /> (Home/Cabin; Commercial Business; Bedr om; Deck; etc.) e ° <br /> BUILDING CONTRACTOR: QJ <br /> A PLOT PLAN MUST BE PROVIDED ON AN B Yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLO r PLANS H <br /> WILL BE RETURNED. p <br /> C <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) �^ <br /> � o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BES 1OWN OR DRAWN TO SCALE. <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BL 1LDINGS/STRUCTURES (EB)AND ALL NEW ^ ,F, <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, I ORCHES AND OTHER STRUCTURES, V. m 6 <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUIL ING(S) I n <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREM NT(S)TO THE ORDINARY HIGH WATER MAF K 3 <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND kREAS,AND(D) LOT DIMENSIONS. N i <br /> 4. SHOW THE LOCATION OF THE WELL (W), SEPTIC TAN (ST)AND DRAINFIELD (DF), AND ALL DIS ANCES w -J) <br /> o <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. _ (1) c Q <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ET(.,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 /> w <br /> NEEDED. I <br /> _ ,D <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW I� I <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. S'.- Z O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION I RESTRICTED ALONG SHORELINE. n I <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. B I- <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC:.,ALLOWED WITHIN THE REQUIRED WATE JLJ,, <br /> SETBACK AREA. (� � <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FC R PRIVATE RESIDENTIAL GARAGE/STORAGI ONLY. a <br /> NOT TO BE USED FOR HUMAN HABITATION. F <br /> 6. <br /> z >u1 rE <br /> 7. : n nasFty <br /> � aa�o5 aw .7. <br /> 1 declare that this application(including any accompanying schedule)ha been examined by me and to the best of my kno ledge p <br /> and belief it Is true,correct and complete. I acknowledge that I am MSPDnsible for the detall and accuracy of all Informatic if - <br /> contained in this application(including any accompanying schedule)and I further declare that I recognize that this informs on I Y <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit I further ac ept all 5 <br /> liability that may be a result of the County of Burnett relying on this lnfDjmation I am providing In this application. 1 agree M <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the abo e- a CI <br /> described premises at any reasonable time for the purpose of Inspection c O =m r Y <br /> OWNER'S SIGNATURE e S 2 <br /> (date) H `�o > .� <br /> ZONING ADMINISTRATOR <br /> � a <br /> TOWNSHIP PERMITS MAY BE REQUIRED 3 a <br /> THIS PERMIT SHALL EXPIRE ONE YEA I FROM DATE OF ISSUANCE M 8 N <br />