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Burnett County 7410 County Road K, No 02,'' �ren,•WI�54` 872 Office of Zoning Administrator a ° <br /> APPLICATION FOR LAND USE PERMITS N {J� <br /> OWNER TELEPHONE <br /> fD O <br /> MAILING ADDRESS C eIJB�ay G"r t1) 2lo _ <br /> PROPERTY ADDRESSVel <br /> LEGAL DESCRIPTION CIA <br /> TYPE OF PERMrr(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK ❑ GARAGE/ACCESSORY STRUCTURE ❑ <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ STAIRS ❑ FILLING/GRADING ❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITION`rk COMMERCIAL ACCESSORY STRUCTURE ❑ S C <br /> STRUCTURE/ADDITION USE: rslXt'r �?fl l�� c <br /> (Home/Cabin;�Clommercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: D // JPCI.1 OAJ <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 1/2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o I� <br /> WILL BE RETURNED. Oil <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) C7 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. d <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, v <br /> AND INDICATE NORTH (N). N l�� i c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) 0 � <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. Q <br /> 4. SHOW THE LOCATION OF THE WELL (W), SEPTIC TANK (ST) AND DRAINFIELD (DF),AND ALL DISTANCES N <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. ' rn <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. y ) <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE qj <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 1 �' 1 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN iCA <br /> J <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: �• <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. , n z LA <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. y <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 I <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. O <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> • =r o00000.. C7 "d <br /> � efD-. RB9B � o, � L=1 <br /> NzoCDnCDoss" x <br /> I declare that this application (including any accompanying schedule)has been examined by me and to the best of my 3 c 1:5 R R R „ ? as <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 <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I w c a ao^_ <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this �� in N b <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to <br /> have access to the above-d rrb o o <br /> esE" d pre�ises at an easonable time for the purpose of inspection. � �`;w ���o o > <br /> OWNER'S SIGNATURE t'N �� —(/ C o oc o 0 0 <br /> (date) o yyn t7 .n Z <br /> ZONING ADMINISTRATOR = o yITI <br /> TOWNSHIP PERMITS MAY BE REQUIRED " ' <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE t' <br /> V� N 0 0 0 0 O <br /> U O O <br />