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R O <br /> Burnett Courcy 7410 County Road K, No. 102, Shm,WI 54872 ONlae of Zwft Ad"nistrdW <br /> APPLICATION FOR LAND USE PERMITS (T <br /> OWNER TELEPHONE <br /> TL F <br /> MAILING ADDRESS l/Q/' �I ! �/A j /7 6-e, 571-A-/ MAI 63/0 <br /> l Z T n <br /> PROPERLY ADDRESS '1 / p a (1DGC/JT>n <br /> LEGAL DESCRIPTION <br /> TYPE OF P9tMR(S): SINGLE-FAMILY DWELLING❑ ADDITION O DECK❑ GARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE ❑ 59.692(iV)GAZEBO❑ STAIRS❑ FILLING/GRADING D CAMPING UNIT❑ <br /> COMMERCIAL BUILDING❑ COMMERCIAL ADDITION O COMMERCIAL ACCESSORY STRUCTURE 0 <br /> da <br /> // J s 3_ <br /> STRUCTURE/ADDIRON USE: ki�'f =� QQ �f /�17R-Y/1 0 u S� z <br /> (Home/Cabin: Commercial Business: Bedroom: Deck: etc.) _ P <br /> O <br /> BUILDING CONTRACTOR: .4' n <br /> (/-}nn�tSlCr'S CCl( (o(a- 3t{5 0$107 0 � <br /> A PLOT BE PROVIDED ON AN 8 Yi X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS o <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) tnn I n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C pt <br /> O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW t�'f 'O = o <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, C> a <br /> AND INDICATE NORTH(N). l� c <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES,(B)BUILDING(S) o J <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. p <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES <br /> TO BUILDINGS,ROADS,LAKE,LOT LINES. v, <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6, IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE �.' a <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER, J Cr �n <br /> NOTE: Bl1ILDSTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DOME WHEN � ..i O <br /> NEEDED. <br /> I� <br /> THIS PERMIT IS SUBIECT TO ALL Conomtx(s LISTED BELOW: G1 r- O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. z G <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <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 <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTULL GARAGE/STORAGE PNLY. p <br /> NO TOB US D FOR HUMAN M BITATION. / //L O <br /> 6. C> <br /> 1_x/7 �p E <br /> 7. <br /> � F �3 <br /> I knowledge <br /> owme that this application ,correct any acooete. I ac howledsdiedule)Lias boon dWrtlrtM by me and to The bat of my 3 P <br /> and UdkF R is true,correct and corrTiebe. i acknowledge tlrat I am reapaeible for the dMag and aooaacy of all <br /> aAmmation odtlaered In this apptkWlon(arWrdi g any accompanying sdvMe)and I further decI that I reepgae that LMs <br /> bdonnatlon I am providing will be relied upon by the County of BrarrN Wisconsin in dela niiWap whedu r to issue a permit. I <br /> furMer accept as liability that may be a road[of the County of Bunaa[relying on this krfonnation I am proNdkg In this o <br /> I agreeaccees to the�m�rto pemdt county officlals ncribed P charged wtln y th for n�y .or allm auttwized Parson m have a 2 g y <br /> a ��oy <br /> OWNERS SIGNATURE � <br /> ( g9aRa= <br /> ZONING ADM INISTRA @ - o a 'tJ <br /> " or <br /> tbe <br /> H c w <br /> WNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> U U g o O O <br />