1996/04/18 - LAND USE - SUB - Certified Survey Map - 19278

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OCL Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ; ; o 0 APPLICATION FOR LAND USE PERMITS 0 TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work y described and located as shown herein. The undersigned agrees that all work shall be done in accor- dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other o applicable County Ordinances and the laws and regulations of the State of Wisconsin. H m c v I 3a�- �7�g OWNER ,O / n TELEPHONE ^0 U il-' f m Z_ HOME ADDRESS^ I�.l 1 � Grlf. W L _ p�� EMERGENCYIFIRENUMBER x311 ROAD NAME C� ��un hain 4a II.C_1 LEGAL DESCRIPTION(see tax receipt) CONTRACTOR__r,_rlrj ++v g O TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION 0 SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION (n',(11 � 1 / o a STRUCTURE/ADDITION USE: 1 V r m (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) r 0 A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. In O DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 -n P rn TZ S 1. All required dimensions or distances to be shown or drawn to scale. n P 2. Show the location and size of all existing buildings (EB) and all new buildings (NB)and indicate m N' North (N). m ` 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. r 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildings, roads, lake, lot lines. 5. Indicate if a walkout basement is planned and show areas to be graded or filled. 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be W signed and dated by the owner. u NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- FORE A PERMIT CAN BE ISSUED. 0 THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. CONDITIONS OF PERMIT: o m 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT s ISSUANCE. r GO 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. �1 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY Z PERMITTED. 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. 5. f 6. y o c 9 m 8Rm* m _. 7. mcyo3 mo �m i in o le2i 1 Z T! E [ 71 8. m o m m I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my �-` '• O m knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of 9 P 9 Po Y all information contained in this application(Including any accompanying schedule)and I further declare that I recognize om o : that this Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Information I am n p providing In this application. I agree to permit county officials charged with administering county ordinances or other ; 3 ii� authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. SIGN HERE w N: (signature of owneerrrooJr building contractor) (date( o ZONING ADMINISTRATOR \ I Irl N N r n N N N N m TOWNSHIP PERMITS MAY BE REQUIRED P . v P . u, u, o m 000000o0 00000000