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Burnett County 7410 County Road K, No. 102, Slren, WI 54872 Office of Zoning Administrator W <br /> APPLICATION FOR LAND USE PERMITS a �. <br /> �ELEPFJONE O66 <br /> K�2�"d �a•n� E/ SJ��g''.•1/ <br /> MAILING ADDREn5 t' sdo <br /> 77n D4. Ct>GCti'c e zu5 <br /> -a 765z } o <br /> PROPERTY AD,9RESS <br /> 3S';' R/I't S / <br /> �r <br /> LTGqL DESCRIPTION <br /> $e„h< 3G� 7KxN-'fa nc• 4J 1e A3 �.S H LJ l P / 27 <br /> DWELLIN /BUILDING ❑ GARAGE/ACCESSORY STRUCTURE.4S ADDITION ❑ STAIRS ❑ y, <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING❑ CAMPINGUNIT ❑ BUNKHOUSE 1159.692(1V)GAZZ_E[B__O�❑ DECK❑ <br /> � Z S-/+ n <br /> STRUCTURE/ADDITION USE: . )(3kz<i C C,,2 a5(D a '� W� <br /> A U 3 Z <br /> ^1(Home/Cabin, CC�ommerci I Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: �irl�-� �� C �K1 of Sq-3i)157 Y� <br /> a8aoshornll'n�A�., J�n &lnl x/830 G <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 y:X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS O <br /> WILL BE RETURNED. m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) O N <br /> 0' 4 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. M 0 O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW C <br /> BUILDINGS/STRUCTURES (NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, to <br /> AND INDICATE NORTH (N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) o <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK e <br /> (OHWM) OF LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. F c <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES r <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. I� <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. n o <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE B Q I <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 /> NEEDED. M <br /> q m <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: m 'n <br /> sa <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n Q ) <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ? J <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 l <br /> SETBACK AREA. <br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. This structure to be used as private residential <br /> O K garage/storage only. Not to be used For human m a <br /> 7. R ^ CatT - y7 <br /> ' habitation. <br /> I declare that this application(Inducing any accompanying schedule)has been examined by me and to the best of my knowledge <br /> and belief It Is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of all Infonnatlon e <br /> contained In this application(Including any accompanying schedule)and I further declare that I recognize that this Information I <br /> am pmviding will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I further accept all c „N <br /> liability that may be a result of the County of Bumett relyingon this Information I am providing In this application. I agree to <br /> permit county officials ch ed with adminlstra q county ordinances or other authorized person bo have access m the above- <br /> described preml masonable time fo of Inspadbn. <br /> SIGN HERE - ^/ /-��-o <br /> (signature o ownerorbbuilding contractor) (date) <br /> ZONING ADMINISTRATOR 1'0 <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE _ 8 <br />