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Burnett County 7410 Co. Rd. K, No. 102, ...ren,WI 54872 Office of ton. Administrator -CD o 0 <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> N � <br /> OWNER /)lvZc/ /'-y /�Cr-h S TELEPHONE <br /> /!�� O <br /> MAILING ADDRESS X00 5- G ST 9- ST A, WIZ SS�oE <br /> 0 <br /> 0 <br /> PROPERTYADDRESS C // <br /> LEGAL DESCRIPTION(see tax receipt) -�F� t4? 7D4 Gco <br /> C <br /> DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ (n ° <br /> TYPE OF PERMIT(S): a <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ <: <br /> STRUCTURE/ADDITION USE: [ d0/i9 i»r s 4 / E c �� ) � UU <br /> (Home/Cabin; Commercial Business;Bedroom;Deck;etc.) d <br /> BUILDING CONTRACTOR: //t- C <br /> CD <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O n <br /> n <br /> " v z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS (EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). W o <br /> 11 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m 3 <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 <br /> BUILDINGS, ROADS, LAKE,LOT LINES. a <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED, 7 ED. N 91 <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, COM C., THE PLANS 2. <br /> MUST BE SIGNED AND DATED BY THE OWNER. I '° E <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERII* ION MAY B ° 1-+ <br /> NEEDED. 2 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. e�/9,t'✓�� 9 0 <br /> CONDITIONS OF PERMIT: '✓F� ! p <br /> I <br /> ISSUANCE.MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMITZO/V// (c uNTj, ) <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 C <br /> SETBACK <br /> V <br /> 6. 3xa CO, <br /> ;= <br /> o' 0cNyo � 3 <br /> Z N mo -I <br /> 7. o -Q m <br /> = v� : m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G) C . c <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of d ° in <br /> M 0 M <br /> : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m o mt7 <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <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 Q d <br /> providing in this application. 1 agree to permit county officials charged with administering county ordinances or other ti <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. o <br /> CDm <br /> SIGN HERE -ley a <br /> (signature' ing contractor) (date) <br /> C <br /> !77Z2�:) <br /> ZONING ADMINISTRATORQ v v� <br /> fA fA EA EA� N <br /> N Cn N N O O <br /> y� � ° OUtUtOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />