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<br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator
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<br /> APPLICATION
<br /> ,�,�FOR
<br /> p LAND
<br /> ,JUSE
<br /> ..PERMITS
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<br /> OWNER w)'/ I (a rY) r'.J„ca 114.1X1v\J` G+-x(�r'•ONE �__l,�O�p_aY�tiis _
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<br /> MAILING ADDRESS O' I M 1 IIY d �� ko.oev�a,, MN SS( 13 R
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<br /> PROPERTY ADDRESS 8 S� 'Kr 1•K PMd, �/�/�6J�� VV, J -
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<br /> LEGAL DESCRIPTION
<br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING❑ ADDITION ❑ DKK❑ GARAGE/ACCESSORY STRUCTURE 3
<br /> BUNKHOUSE❑ 59.692(1V)GAZEBO❑ STAIRS❑ FILLING/GRADING❑ CAMPING UNIT❑
<br /> ro
<br /> COMMERCIAL BUILDING❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE❑ S
<br /> STRUCTURE/ADDITION USE: o
<br /> (Home/Cabin;Co ercial Business; Bedroom; Ded(;etc.)j p
<br /> BUILDING CONTRACTOR: LL
<br /> W5�14 UBoth duo R-I Q I swarth I IN-4 54oa 1 0
<br /> A PLOT PLAN MUST BE PROVIDED ON AN 8%X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C o .,
<br /> WILL BE RETURN. Ll cQmV-* q-7G53G / phftvo,Ua-Sqe-If q7
<br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARTAL OR TOP VIEW) POi b
<br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C A
<br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW iti h0 o
<br /> BUILDINGS/STRUCTURES(NB),INCLUDING DECKS,PORCHES AND OTHER STRUCTURES, O
<br /> AND INDICATE NORTH(N). V
<br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S) b
<br /> TO CENTERLINE OF ROAD, (C)BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK 1
<br /> (OHWM)OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D)LOT DIMENSIONS. l7
<br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES
<br /> TO BUILDINGS,ROADS,LAKE,LOT LINES. )
<br /> S. 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.,THE
<br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER.
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<br /> NOTE: BUILDING/STRUcruRE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DOME WHEN ti d
<br /> NEEDED.
<br /> THIS PERMIT IS SU8IECT 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. �VJJ w q
<br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED U O m Jj
<br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLO R 9j
<br /> SETBACK AREA. --I_— ---U
<br /> S. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRN ff=G E ONLY. `}$J��f',
<br /> NOT TO BE USED FOR HUMAN HABITATION. E
<br /> 6. ;w64%" s 6- i zo � Fn... Ajr,.t OCT 2 4 2011
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<br /> 42.
<br /> I declare that this appYcWm(Indudhq any aavnPanyi q schedule)has been emrhahed bed my o R e P r ra.
<br /> Imowledge and bells t Is true,correct and mrrrpeee I admowkdpe mat I an responsible tar amracy of am n m E E
<br /> hdartrrallon rant kind In dit application(brdrdykV any
<br /> arccesWa yi g schedule)and I Napery dyWsre that I recoWdre that Oft 9 °.9 D to
<br /> htonnabOn I am prow NV�be resod upon by the CauntV oftaanalt Wisconsin In deto"**V vuhaherto loan a Paco&- I
<br /> /other ampt ad YWNty Nat may be a rearat ofthe County of Barnett rslyYq an tlas YhforrrhaUorh Ian pnovidi g In tlus Yr C _N: N b
<br /> appk~. I apse to PM*=Xlty OT4als charged with 9&ft t-*V maty ordinances or aMvlad person to have
<br /> acres m the above-daaeed panlsa m reasonable thee for the Purpose of Inspection. m 5 g W f]
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<br /> OWNERS SIGNATU �'=' 'l I on H c m n y M z
<br /> (date)
<br /> ZONING ADMINISTRATOR rfG�T ��• 6 L� �� y, _ a
<br /> CF U ew T KRAITS MAY BE REQUIRED
<br /> PDr TY\Q*J y e THIS PERMIT SHALL RE ONE YEAR FROM DATE OF ISSUANCE , " N«»H
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