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JUL-15-2001 14:28 BURNETT COUNTY GOU CENTER 17153492102 P.01i01 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS ° <br /> N 0 <br /> OWNER FLOYD & PATRICIA SKOGSTAD TELEPHONE 612 973-0220 WK O v` <br /> HOME ADDRESS 3843 TYLER STREET NE " OD10 <br /> r � <br /> EMERGENCY/FIRE NUMBER 23624 ROAD NAME OLD HWY 35 11 <br /> LEGAL DESCRIPTION (see tax receipt) TOT ? GOV LOT 7 SEC <br /> ,. VOLVOT��, 16 TWN 38N of R17W <br /> DWELLING/BUILDING ❑ GARAGEIACCESSORY STRUCTURE ❑ ADDITION X❑ PRIVY ❑ o <br /> TYPE OF PERMIT(S): <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ �: <br /> c <br /> STRUCTURE/ADDITION USE. CABIN e <br /> (Home/Cabin;Commercial Business; Betlroom; Deck;etc,) <br /> BUILDING CONTRACTOR; OWNER 3 r <br /> d <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN B'/r X 11 SHEET OF PAPER. ANY INCOMPLETE OR 2 <br /> ILLEGIBLE PLOT PUNS WILL BE RETURNED. -3 <br /> -3 <br /> x 0 W <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O a <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. T O ? <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE n A <br /> NORTH(N). m <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDINGS)TO ALL LOT LINES,(e)BUILDING(S)TO m `93 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. <br /> d. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO r1 I <br /> BUILDINGS,ROADS,LAKE,LOT LINES, <br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> G. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR,ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. -I ; <br /> � � I <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: P <br /> 1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE, <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. (r <br /> 4 NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. C <br /> cin obi DOa <br /> 6. O '0 <br /> g � r, q� � � <br /> a mCy �' o� 3 <br /> 7, P B 0 ' <br /> I declare that this application (including any accompanying schedule) has been examined by mo and to the best of my: 17 <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy ofy u C <br /> all information contained In this application(including any accompanying schedule)and I further declare that I recognize O <br /> that this information 1 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 O ' <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other E a <br /> authorized person to have access to the above described promisor at any reasonable time for the purpose of inspection. <br /> ^ m i <br /> a1GN HERE <br /> (signature of owns or I g contractor) (date) I <br /> !ONING ADMINISTRATOR r Q <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> TOTAL P.01 <br />