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n � . <br /> Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> ° APPLICATION FOR LAND USE PERMITS 3. <br /> 0 <br /> (612) C <br /> OWNER RoERT D. NEININaeg TELEPHONE q57 96811 m <br /> HOME ADDRESS 2q3 Z KT H 5T E INVER GROVE NETS SIN. 52)76 <br /> r Q <br /> _ o <br /> EMERGENCY/FIRE NUMBER (0-397 ROAD NAME C/,QC Lt RD. <br /> LEGAL DESCRIPTION(see tax receipt) t oT ti T &off LOT 5 S2 T 4o AJ R M.W rn <br /> y o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION Cr <br /> S. <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT,,—;,,,SUBDI ISION `; <br /> � c iv <br /> STRUCTURE/ADDITION USE: BI'y �y( `� t " '9` /�� fir <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR m a. <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. i D ���� �q@6�SI p�� 0 N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) L'07 1 (�NS1b1 T o <br /> d S�u�da 7t�aY T o Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. pq{W�r,tk OW e'er m <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE IF <br /> C n <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO M 3 <br /> a <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, Z <br /> STREAM OR RIVER. ° <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- 9-) <br /> INGS, ROADS, LAKE, LOT LINES. O <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N { <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS r- <br /> MUST BE SIGNED AND DATED BY THE OWNER. o W <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE r <br /> ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT Q <br /> ISSUANCE. ` <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. �J <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, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. z -0Od 0 0 .0 <br /> 5d m <br /> 6. <br /> n <br /> N <br /> 7. oco rn? <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ; g c <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of n r <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize 0 m m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- iu 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 ordinances or other a m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. n <br /> � mE <br /> SIGN HERE r <br /> ( na a of owner r b 1151 contractor) � ,j (date) ' <br /> ZONING ADMINISTRATORAll ! ' N N in N N Vt <br /> ' N NOU1 � O <br /> TOWNSHIP PERMITS MAY BE REQUIR b `----- --- - o 0 0 0 0 <br /> 1WC sem- -ig - <br />