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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator _U c) z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> r yJ�\ <br /> N O V <br /> N <br /> C <br /> OWNER Rc er Deml TELEPHONE 507-45i-6388 <br /> v W <br /> m <br /> MAILING ADDRESS 3695 E School St Owatonna NN 55060 v ° <br /> r � <br /> 0 <br /> PROPERTYADDRESS 27:;39 E Connors Lace Rd Webster W'I 54893 <br /> 36-19 518/01 S36/T40/R16W Acres . 440 <br /> LEGAL DESCRIPTION(see tax receipt) 2-40-16-35-0 03000 Lot 2 CSN V 1 P 130 1 c m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ® ADDITION ❑ Cto 0 <br /> TYPE OF PERMIT(S): o <br /> FILLING/GRADING El CAMPING UNIT ❑ SUBDIVISION Elor '� <br /> shed _ � k gg l Ago Gazebo N <br /> STRUCTURE/ADDITIONOSE: $t G r d,y e 0 �) <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) rn <br /> m <br /> BUILDING CONTRACTOR: S 2 l f (� <br /> m 1 <br /> M <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 61AX 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m - <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> -n 0 <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n 3o <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> n <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 <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> Icy <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS zS0 ) <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o l <br /> CONDITIONS OF PERMIT: <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 IN <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5.J V/I r <br /> A W D O D O <br /> �" °t � c0i � m <br /> nF m <br /> 6. 3am x 0 <br /> a m C y " o 3 <br /> 7. z w m ° ` ' o <br /> o -n <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my ��) — r^ A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of " m va C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize Cl m� o v <br /> that this information I am providing will be relied upon by the Coun flSn <br /> i7eil <br /> n t a, ning whether to is- <br /> sue a permit. I further accept all liability which may be a result of u i r�this information 1 amproviding in this application. I agree to ennit county officials ordinances or other o <br /> CD rn <br /> authorized person to h e access to th a ve cribed premise at any reasonable time for the urpose of inspection. . <br /> (D o <br /> iliAR 8 200 <br /> SIGN HERE <br /> (signur of o r building contractor) (date) a <br /> ZONING ADMINISTRATOR BURNETT COUNTY <br /> ss -A N)01N)N)00 <br /> N U t N N O O <br /> UtOUNOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />