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office of <br /> Burnett County 74�APPLICATIONSIFOR ILAND <br /> USE PERMITS Zoning Administrator o <br /> r <br /> N <br /> N <br /> C / I� <br /> -i TELEPHONE (G S( - c4' S( - (0 2'qE - V <br /> OWNERm <br /> pp � O <br /> MAILINGADDRESS S 7 20 13 111 r22 3>l,• l7 N E (')•}It S��t (�/o�C tf�S MN r -. <br /> PROPERTYADDRESS ?' )(.:S I Tft '- do �'} OD`d Z"(" t <br /> �cJQ a1 t 1-,c 'FZ <br /> 4:-01 C5OA 1/Z P`I'I 1 ;; U <br /> LEGAL DESCRIPTION(see tax receipt) 51 <br /> S�c4'.o, ? 3� TCwti1 ���6x15 La-f 1 f5m VI'O�S9 J <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ n 0 .Y <br /> TYPE OF PERMIT(S): <br /> FILLINGIGRADING ❑ CAMPING UNIT ❑ SUBDIVISION L <br /> 3 o t = <br /> c <br /> STRUCTURE/ADDITION USE: Deck; etc.) <br /> m (� <br /> (Home/Cabin; ComrSlfer E Business. Bedroom; m <br /> CP—III AO I-V <br /> BUILDING CONTACTOR: <br /> .S It rM p E� <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN BX X 11 SHEET OF PAPER. ANY INCOMPLETE OR O 3 Q <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. M N <br /> 0 a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) r Z <br /> n m A <br /> J. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C �- o <br /> y 3 <br /> NORTH(N). m v <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF o <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 ry <br /> BUILDINGS,ROADS, LAKE,LOT LINES. N <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 PLANS o <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> 0 <br /> NEEDED. o �I ) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. N <br /> CONDITIONS OF PERMIT: I ) <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT c` 1 <br /> ISSUANCE. F TREES AND VEGETATION IS X� <br /> 2.3. NO GORADING OR SHOREVAL OR CUTTING OLAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY LIN <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. /_ �G jo F-t- i-Ot" <br /> s. C-1(gsasf 0r*u' c. Sfiru e M d d R o a f m <br /> 3 <br /> ❑ B B n n n m F C <br /> -o m C N o <br /> 6. Z cwmo <br /> P m T m <br /> 7. = » A <br /> 'c , C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of mof 1y _ @ B A <br /> m � m <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy ze <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> m n : <br /> that this information I 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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinanfces or ofthher m <br /> authorized person to have access to the above described premises at any reasonableQmle7! v <br /> IIS i �j 1J' I '� <br /> SIGN HERE - (date) <br /> ( at re of o or building contractor) 01:0 I,� <br /> ZONING ADMINI OR <br /> ,/ o � ocwi� rwi+ <Nino <br /> TOWNSHIP PERMITS MAY BE REQUIRED BURNETT COUNTY <br /> THIS P RMIT,SHALL EXPIRE ONE YEAR FROM TE OF ISSUp@IING <br />