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Burnett County 7410 Co. Rd.K, No. 102,Siren,WI 54872 Office of Zoning Administrator c c <br /> APPLICATION FOR LAND USE PERMITS ] <br /> w � <br /> w <br /> OWNER Rober-f L� Kiemen/ (612) 772-IISZ <br /> TELEPHONE <br /> HOME ADDRESS12 / SAS S ���Al% /J I InAl =2 % <br /> 0 <br /> EMERGENCY/FIRE NUMBER 2992-2, ROAD NAME R1ye_f 0AA-s <br /> t p 11 � r <br /> LEGAL DESCRIPTION(see tax receipt) <br /> t-D�" S f� 1 vef LAK c R ca l`T <br /> . / <br /> TYPE OF PERMIT(S): DWELLING/BUILDING V GARAGE/ACCESSORY STRUCTURE ADDITION a <br /> 5. <br /> w <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> m <br /> STRUCTURE/ADDITION USE: }fo-In e /C AB I N <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR In ro <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. FA <br /> ll <br /> FCTIONS <br /> FOR PLOT PL6bI 1213MIbig; (AERIAL OR TOP VIEW) n a J <br /> In2 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m S :b2 .SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE C 0 <br /> NORTH(N). o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. c <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD9,3 <br /> - <br /> \ INGS,ROADS,LAKE,LOT LINES. <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 <br /> MUST BE SIGNED AND DATED BY THE OWNER. <br /> v � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE a ° <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o (� <br /> CONDITIONS OF PERMIT: u <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. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, <br /> PONDS, RIVEft UNLESS SPECIFICALLY PERMITTED. �$ � ���,f I <br /> 5. Adw//o.✓S �&'cte"100 ��s cmc-f� ;p 'v 0 to- <br /> 6. <br /> 6. �(l // `^i <br /> 7 ! CY_' woS3 <br /> /M / � w S m <br /> 7. wu <br /> I "�"CJ�-. /l-cy� l0 6 Pl QZ l�'v o ` Cn E i T <br /> I declare that his application (including any accompanying schedule) has been examined by me and to thWbOSt of my E ' IS <br /> knowledge a d belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of ii a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize : o ; , G <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- d <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 m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other E e <br /> authorized person to have access to the above described premises at any reasonable time oss of inspection. T <br /> SIGN HERE 1 19q <br /> (sign re o ner or builds g ntractor) ! (date) <br /> �. ,'. � t <br /> ZONING ADMINISTRATOR Z us w w a to uw� <br /> o000000 <br /> TOWNSHIP PERMITS MAY BE REQUIRED - o 0 o 0 0 0 0 <br />