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G z <br /> Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administrator g � <br /> APPLICATION FOR LAND USE PERMITS <br /> 7 � <br /> OWNER Miller Revocable Trust TELEPHONE 715-259-3257(Northland) a. <br /> d <br /> m <br /> MAILING ADDRESS 8182 Ideal Ct Forest Lake MN (�,y <br /> PROPERTY ADDRESS 4530 Hideaway Rd Danbury Wi a CEJ <br /> o <br /> LEGAL DESCRIPTION Lot i CSM V 13P173 Located in Goc Lot 4 Section 26 T41R15W S' <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ❑ ADDITION ❑ DECK X GARAGE/ACCESSORY STRUCTURE ❑ rn <br /> BUNKHOUSE❑ 59.692(1V)GAZEBO❑ STAIRS❑ FILLING/GRADING❑ CAMPING UNIT❑ <br /> COMMERCIAL BUILDING❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ S' <br /> STRUCTURE/ADDITION USE: c <br /> (Home/Cabin;Commercial Business; Bedroom; Deck,etc.) <br /> BUILDING CONTRACTOR:_Northland Builders Inc <br /> n <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 rh X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS G o .. o <br /> WILL BE RETURNED. y <br /> m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW o <br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, J 3 <br /> AND INDICATE NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) .oz� <br /> TO CENTERLINE OF ROAD,(C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 5' <br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES q <br /> TO BUILDINGS,ROADS,LAKE,LOT LINES. ti N O <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.,THEc i <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 9U 9,)NEEDED. _q cPi <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: '� E' a <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. Z I O <br /> 3. 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. �I <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 7. annn L)6 �q � <br /> I declare that this application(including an accompanyingschedule has been examined F K 3 3 A Q 8 =. SSS111 <br /> PP L ng Y ) by me and u the best of my anon 9e g o �_�_ ° w <br /> and belief it is true,correct and compote. I acknowledge that I am responsible far the detail and accuracy of all information �• � <br /> contained in this application(including any accompanying schedule)and I furtler declare Mat I recognize that this information I .e c. D D N <br /> am providing will be relied upon by the County of Bum Wisconsin in dela ing whether bo issue a permit I further accept all 9 $w 7 <br /> liability that may be a result of the County of eumett 'ng on this iMor I am ing in this application. I agree to tri (L.- <br /> permit <br /> county officials charged with adminislratlrg my ordinances or utho" pe m have access to the above- ,� o ; <br /> described premises at any bte tlme for M of inapectlon. m mino S iS -r w <br /> W w N <br /> 3 3 � � y$8o8Sy <br /> OWNER'S SIGNATURE �0 'c .. <br /> date o co <br /> ZONING ADMINISTRATOR /i ( V'a y ' M <br /> ��� I Qn( H N oc w B f�y1 <br /> i RCE g <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FRO DATE F; ANCE <br /> P&fi,-,�P,, e�te/pie'4ed iy b_/ - PATE "it �s 3-a3-) 0 ;5 9 o <br />