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Burnett County 7410 Co. Rd. K, No. 10r, oiren,WI 54872 Office of Zt g Administrator@ Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r <br /> OWNER C/f {'-I S �' L�/ /1 cf H'1 TELEPHONE <br /> ° O� <br /> MAILING ADDRESS <br /> / / / <br /> PROPERTYADDRESS �'SD �i'olTwn �� GC/£bJ�Er� (�T' <br /> LEGAL DESCRIPTION(see tax receipt) 07 J ��K?44me aNGrs 1 U <br /> DWELLING/BUILDING NJ GARAGE/ACCESSORY STRUCTt IRE ❑ ADDITION ❑ O o� <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ,� CAMPING UNIT [I SUBDIVISION ❑ a <br /> STRUCTURE/ADDITION USE: o 101" 1 0 r)-) -"�)R <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: f 4 rT u-' /!t! /Jr&7 , t <br /> �7"x,2 �57�% W1 7-5-17,9 . f-r F <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/2 X 11 SHEET OF PAPER. ANY INC MPLETE OR / 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. �StS ;a,(5 � X011 \ O c <br /> J 1 t� ,� M <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) SQµ ni 0��y. 3 -n a <br /> r,1 � of ns T o --t- Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Mir ON 9 m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH( ) C 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m o <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. ° <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO C <br /> BUILDINGS, ROADS, LAKE, LOT LINES. e, 6 g: �F/F rrn%n rn a4:'7-e r S ,o 7.-e <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. —I-V N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS © ° ` <br /> MUST BE SIGNED AND DATED BY THE OWNER. 'C f b <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN Fno <br /> NEEDED. t � <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: (� 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. C) <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> � cooni m n 0Q0I-0r1 <br /> 6. m x.o nm yam <br /> a omcy `" o � 3 <br /> Z cwmo <br /> 7. o m �t � <br /> _ c, : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my A <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of C <br /> d <br /> all information contained in this application(including any accompanying schedule)and i further declare that I recognize : : m <br /> that this information 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am i o <br /> providing in this applicati . I agree to permit county officials charged with a i_ r her m <br /> authorized p o h access to the above described premises at any reaso i =r %r i o ° 'o <br /> T <br /> m D : <br /> / CL a�tl t ..® C a : <br /> SIGN HER �" : n <br /> (s' natu of own or (ding contractor) (date o <br /> C 0 <br /> ZONING AVNISTRATORDC <br /> BURNETT COUNTYo o m o o N <br /> C O N U W W N O <br /> G ONONUt U1 O <br /> TOWNSHIP PERMITS MAY BE REQUIRED ZONING <br /> THIS PERMIT SHALL EXPIRE ONE YEAR 0 byTE OF ISSUANCE <br /> [ka/f 04+i-'e /l�D/� 1 /� I(� �y <br />