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11/21/2007 10:54 FAX 612 673 2517 CITY OF MPLS FINANCE 0001
<br /> °'NOV. 21, 20077 10: 39 AM SULLIVAN D/HH 6126685025 NO, 1094 P. 2�ooa
<br /> Burnett County 7410 County Road K, No, 102, Siren,WI 54872 Office of Zoning Administrator
<br /> APPLICATION FOR LAND USE PERMTfS g
<br /> JCTELEPHONE (
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<br /> COTTAdis �(.5r, L� Is 96
<br /> MAILING ADDRESS
<br /> 1;5
<br /> OWNE
<br /> R 422-- S14ssy
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<br /> PRDPERTY ADORE95 3.23 2 E _ tZed ILS (,4aG,e PO (ax S'17;Q I.71
<br /> G
<br /> LEGAL CRIprloN J
<br /> a tJ Glar<7a 16 w
<br /> SINGLE FaMILY DWELLING GARAGE/ACCESSORY UCTURE❑ ADDITION 0 STAIRS 0
<br /> TYPE OF PHtMTT(S)t
<br /> FILLING/GRADING [I CA PING UNIT O BUNKHOUSE O 59,682(1V)GAZEBO 0 DECK 0
<br /> STRVCIURE/ADDrTION USE: 416!� y
<br /> (�, (Home/Cbbin; al 6uslness: Bedroam, OwX,, etc,)
<br /> BUILDING OONTRACTORIRsod"Q'r OF�'I'�QQ�'k ! CC
<br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 th X11 SHEET OF PAPER, ANY INCOMPLETE OR=gGIBLE PLOT PLANS J
<br /> WILL B8 RETURNED.
<br /> DIRECTIONS FOR PIAT PLAN DRAWING: (ARIAL OR Top VIEW)
<br /> I. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE,
<br /> 2, SHOW THE LOCATION AND SIZE OF ALL E)UST'ING BUILDINGsmRUCTLIRES(EB)AND ALL NEW Q n
<br /> BUILDINGS/STRUCTURES(NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, i-1 1s
<br /> AND INDICATE NORTH (N). Illppp000 L
<br /> 3, SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)SUILDING(S)TO ALL LOT LINES, (B)BUILDINGS) I
<br /> TO CENTERLINE OF ROAD,(C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK
<br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND (D)LOT DIMENSIONS, N
<br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIED(DF),AND ALL DISTANCES
<br /> TO BUILDINGS, ROADS,LAKE,LOT ONES. B'
<br /> S. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED, n W a
<br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER, BUILDER,CONTRACTOR, ETC„THE
<br /> PLANS MUST BE SIGNED AND DATED BY TME OWNER. 2 (�
<br /> NOTE- BUILDING/STRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MY BE DONE WHEN
<br /> NEEDED. I $�
<br /> THIS PERMIT IS SUBACTTO ALL CONDITIONS LISTED BELOW!
<br /> 3. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF pERMIT,
<br /> w
<br /> 2, REMOVAL OR CUTTING OF TREES AND VEGETATION LS RESTRICTED ALONG SHORELINE, a
<br /> 3, NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED, I\
<br /> 4, NO STRUCTURES,INCLUDING RETAINING WALLS,ETC„ ALLOWED WITHIN THE REQUIRED WATER Q-
<br /> E
<br /> � C
<br /> S&1'BACK ARRA. �
<br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY.
<br /> NOT TO BE USED FOR HUMAN HABITATION. Q
<br /> 6.
<br /> 7.
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<br /> mom this application(including any bcoNepany"schedule)has been examined by me and to the best of my Wwwledge 4 d e
<br /> and begtf R is true correct and complete. i aclmoWlodge that[am reslamalbk for the dgtell and awmacy of all Information • e g E: 1 1
<br /> contained In this a"Iftiation(Including IRY amcmpanybao sdradule)and I anther declare that I retogtdte that this bRarr„ation I
<br /> am Pmvldrhg Will be relied upon by the County of Burned Wisconsin In doll p thingWhether m Ispa,a
<br /> permit. 7 FWrIheredto ag e„ Lr9 M y
<br /> cnydt that may be officials r sulthang of the adminounty of Bong co unity an Bde,or natkinathera i sm Prd PeMg m oda l,c aixecia t t ogee co ((v?RVR5Z5 G
<br /> peninvcountyFire sevt yr ed With s time
<br /> purpose
<br /> ardMarabs or Otherauthottred person OD have access t9 ora above- a3
<br /> deaanoed pnmisH at any reasonaBa ome for the purpox of+n ecila ,
<br /> OWNER'S SIGNATOR 404,, Z/,ZOo T n : g g C 2
<br /> ZONING ADMINISTRATOR m la
<br /> TOWNSHIP PERMITS MAY BE REQUIRED
<br /> THIS PERMIT SMALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE d
<br /> pe/✓vr� leek✓ lel !v l�e�,Los,� �c �r , >/ ag-�
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