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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator - - <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER G— PYA . SwT 7 TELEPHONE 612 _2-7D_305 Y <br /> MAILING ADDRESSV^/8S�T 1215TJC1 IfN C- BLAINE , MN 5544q VJ O <br /> PROPERTYADDRESS 6S20 HAYDC—N LAKE RD. DAN6WY ,W1 521-S30 l <br /> LEGAL DESCRIPTION LOT 3 GSM V 12, P f52 (IN 60V LUr S � fRM1 <br /> TYPE OF PERMIT(g): SINGLE-FAMILY DWELLING❑ ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE 11 L/ n <br /> -. <br /> 99UNKHOUSE IV 59.692(1V)GAZEBO Cl STAIRS CIFILLING/GRADING 0 CAMPING UNIT 11l <br /> ZX 14J <br /> COMMERCIAL BUILDING❑ COMMERCIAL ADDITION 0 COMMERCIAL ACCESSORY STRUCTURE 0 <br /> STRUCTURE/ADDITION USE 3UNKFFL�USE <br /> f, (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: OWNER <br /> O � <br /> z < <br /> A PLOT PIAN MUST BE PROVIDED ON AN 8'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. III—J <br /> DIRE. ALL FORPLOT <br /> DIMEPUNNSIONS <br /> DRAWING: (ACES O ESHOWTOP VIEW) <br /> O <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. i' = <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW C> 9 <br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, <br /> AND INDICATE NORTH(N). Z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BG(5) <br /> TO CENTERLINE ROAD,(C)BUILDING MEASUREMENTTHEMARK <br /> S)TO THE ORDINARY HIGH WATER MARK G <br /> (OHWM)OF LAKE,,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. , <br /> 9. SOON/THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELO(DFj,AND ALL DISTANCES <br /> TO BUILDINGS, ROADS,LAKE, LOT LINES .� <br /> 5. INDICATE IF A WALKOUT BASEMENT PLANNED AND SHOW AREAS TOGRADED FILLED. <br /> B <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE - DHyCCJ!� <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN 1 r. Q J <br /> NEEDED. `a <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. (1 m <br /> —' -NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. - <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/5TORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION, r <br /> 6. <br /> „ p7. <br /> > nnnn > od <br /> Fn ,', 333n dt to <br /> I declare that this a application <br /> pp (including andcmplete. Iacknowlede)M1age t been responsible <br /> meandtoll and accuracy <br /> 3 •2 _ _ <br /> knowledgea contained <br /> it in this a correct and rouding a yaccompa ging schedule) <br /> ule)and Ifu further <br /> declarhe e <br /> that <br /> t Irecognize thOf at <br /> y <br /> information confainetl in Mizappliwtion(in<ludingany accompanying zcM1etlule)andifurther tledare Na[Irecognize Mathis > m `P,,,° <br /> information I am providing will be relietl upon by the County of Burnett Wisconsin in determining whether[o issue a permit [ 2 - M <br /> furtheracceptall liabililythat may bea resultofthe Countyof Burnett relying an this information lam provitlingin Nis _ �'+ � - _r„ 7 <br /> application. Iagree M permit county ofhdals Charged with adminixtrating county ordinances or other authorixetl <br /> have access to the above-des 'b d premis a ny reamnable time for the purpose of inspection. B a > u u f7 <br /> � of <br /> OWNER'S SIGNATURE �"�' <br /> ZONING ADMINISTRATOR U IIv_ II r�uS 2 a e n cri <br /> t WNSHIP PERMITS MAY BE REQUIRED <br /> APR 2d 2014 d • ` a <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ANCE _ <br /> BURNETTCOUNTY - � <br /> ZONING uus » U � <br />