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AUG-31-2010 10:08H FROM:HOUSE OF WOOD 7154728530 70:7153492166 P.1 <br /> Burnett County 7410 County Road K, No. 102, Siren, WE 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS a IZ <br /> OWNER TELEPHONE (o l2"ZJB't-32t3 MJ <br /> -it L t .� T.<.las P Sc1,.ec t t Tic 2d2 1 <br /> MAILING ADDRESS <br /> ll3"'( 24t.T' A I Z.mA ,,n,A AAA SS39icir v <br /> PROPERTY ADDRESSl <br /> z5z5K &;1c <br /> LEGAL DESCRIPTION S1iO <br /> l.0 w o F �► I�z 5SE 5zes T39N R 15W a <br /> TYVE OF vERM11(5): SINGLE-FAMILY DWELLING ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE 0 I m <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS D FILLING/GRADING 0 CAMPING UNIT 0 <br /> COMMERCIAL BUILDING 0 COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 <br /> n/t � 1 � J <br /> STRUCTURE/ADDITION USE: rt.ru&r7 IGaS Acr d 7, <br /> (Home/Cabin; Co martial Business; Bedroom; Deck; etc.) P <br /> BUILDING CONTRACTOR: 6, 1C <br /> 0 S <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 Ya X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. e <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW tmrl <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, n l <br /> AND INDICATE NORTH(N). N Z O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S) 'G <br /> TO CENTERLINE OF ROAD, (C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK I ' <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND (D)LOT DIMENSIONS. p Qy <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD (DF),AND ALL DISTANCES I <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 <br /> 6 IF SEPARATE PLANS ARE PLANS MUST BE SIGNED AND DA ED BY THE OWNER� ENGINEER,BUILDER,CONTRACTOR, ETC.,THE a g <br /> 3 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE WHEN U1' <br /> NEEDED. N �) <br /> THIS PERMIT IS SUB]ECT TO ALL CONDITIONS LISTED BELOW: ��T (OA1 <br /> lJ T <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. a -1 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. "' I <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER {IIIC I <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. C] <br /> 7. nnn e <br /> 1 declare that this application(Including any accompanying schedule)has been examined by me and to the beet of my <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 I further declare that I recognize that this g >>mom$ <br /> 09 <br /> Information I am providing will be rolled upon by the County of Burned Wisconsin In determining whether In Issue a permit. [ S a a:— <br /> Iurther accept all liability that may be a result of the County of Burnett relying on this Inf mining <br /> 1 em providing In this B =a*z <br /> ePPIlution. I Ogres to permit county officials charged with administrating county ordinances or other au providing <br /> person to have <br /> access to the above-described promise at any reasonable time for the pu of Inspection. 6 <br /> > 8 <br /> OWNER'S SIGNATURE pArtAri4tZ� n '�l�C/l. �S L 2C `2 p"L>�' 8 0 <br /> date 'a > € S c z <br /> ZONING ADMINISTRATOR_ <br /> TOWNSHIP PERMITS MAY BE REQUIRED «. r <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE u U o o$ <br />