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I <br /> Burnett ounty 7410 County Road K, No. 102, Sirery, WI 54872 Office of Zoning Administra r ' z <br /> Sedan 2� APPLICATION FOR ND USE PERMITS <br /> fok^tAof y0 were 6th-75/-��/8v� <br /> 'TELEPHONE4.4. <br /> i l.K �Me <br /> MAILING ADDRESS /J 7l Aolswr v� J � �� S J9 O <br /> PROPERTY ADDRESS / dV <br /> a <br /> LEGAL DESCR P ION y.y- v, <br /> SINGLE FAMILY DWELLING ❑ GARAG A ESSORY STRUCTURE ADDITION ❑ STAIR c <br /> TYPE OF PERMIT(S): n <br /> FILLI�{G/GRADING ❑ CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECK 3 <br /> /BBlL�1J p O L A f7 S I <br /> STRUCTUREMDDITION E: <br /> (Home/Cabin; Commercial usiness; Bedroom; Deck; etc.) _ <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Yi X11 SHEET OF FNIPER, ANY INCOMPLETE OR ILLEGIBLE PLOT Pk kNS C <br /> WILL BE RETURNED. a < <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIE ) �I ,� 9 <br /> n I�✓�J o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <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, m m <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: ( ) BUILDING(S)TO ALL LOT LINES, (B) BUILDIN (S) c <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK ) o <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. c :n z <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF),AND ALL DISTAr,CES �. <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. G c <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., HE _ 1 <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 W1 EN rl y <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> r z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. ' a <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE AL OWED UNLESS SPECIFICALLY PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER N 1 <br /> SETBACK AREA. 64 <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW I OR PRIVATE RESIDENTIAL GARAGE/STORAGE C NLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. T � D�'� � a � <br /> r H v r c n <br /> w n > EF <br /> 7. <br /> I declare that this application(Including any accompanying schedule)has been examined bymeandtDthebestofmyknowicige <br /> and belief It Is true,correct and complete. I acknowledge that I am a sponsible for the detail and accuracy of all Information o o 2 = ! a <br /> contained In this application(including any accompanying schedule)and 1 further declare that I recognize that this informatio V N <br /> I o =. w w ti .p <br /> am providing will be relied upon by the County of Burnett Wisconsin Ir determining whether to Issue a permit. I Further accel[all <br /> �� <br /> liability that may be a result of the County of Burnett relying on this I formation I am providing In this application. I agree to ^ <br /> permit county officials charged with administrating county ordinances or other authorized person to have access to the above H A <br /> described premises at any reasonable time for the purpose of Inspection. 9.I <br /> / R n <br /> c= <br /> ✓l Z 2�V c n g Z <br /> OWNER'S SIGNATURE (date) ` 6y c > M <br /> y r 0 � <br /> ZONING ADMINISTRATOR .S <br /> c <br /> 'n <br /> TOWNSHIP PER MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br />