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Burnett County 7410 Co.Rd. K, No. 102,Siren,WI 54872 Office of Zoning Administrator b1 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> OWNER I-6AIVA 6601we12 TELEPHONE 763- q2o- q,7_s{a o <br /> Ft <br /> MAILING ADDRESS {(,/S y(S[ - /Q' 7 ,4 LirIV, P(E 64Z, Uy MN 55949 ` ° <br /> PROPERTYADDRESS fzf� ��LD wBV' O L.ANOr I o <br /> G� TD 3 TOW/J -3zF-- N id fLPOWO00 jIR/Rtl,1 —. <br /> r <br /> LEGAL DESCRIPTION(see tax receiptJ��� ) ' A 1/Z9 /A.lr GFT 1-0 1- 1 7gq H3 y39do Q <br /> DWELLING/BUILDING ❑ GARAGEIACCESSOHY STRUCTURE I ADDITION ❑ � Z7zsS re <br /> TYPE OF PERMIT(S): `o <br /> FILLINGIGRADING ❑ CAMPING UNIT ❑ SUBDIVISION L <br /> STRUCTUREJADOMONUSE. Pcj46 Qf4/t01Aje- - OT024e-C <br /> (Home/Cabin: <br /> Comm <br /> e <br /> rcial Business: Bedroom: Deck: etc.) <br /> BUILDING CONTRACTOR. X17 L-/Y/rt/y/U L•f�//e Jl4 rt INC. <br /> � <br /> A PLOT PLAN MUST 8E PROVIDED ON AT LEAST AN B'/.X 11 SHEET OF PAPER. ANY INCOMPLETE OR 9l <br /> '3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> A u <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O $ 0' <br /> T <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. A m z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(N8)AND INDICATE m A <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S)TO m �• 3 <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 GRAINFIELD(OF),AND ALL DISTANCES TO ff1� <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. w <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. 00 3 <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW, o �. <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. 1•� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. r ' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WAI IS FTC Al I OWFn WITHIN THF RFOI IIRFD WATFR O <br /> S SETBACK AREA. This structure to be used as Private residential <br /> garage/storage only. Not to be used for human A ed o non o v <br /> 6_ habitation. x9 d ^ s A <br /> w. cT. 2 Amo : o9 <br /> n N T m <br /> I declare that this applicatlon (Including any accompanying scnedme) ties dean examined by me and to the best of my wrvxx� =c, C <br /> knowledge and belief it is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy of V'< l go <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize m Er u m <br /> that this information I am providing will be railed upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue a permit. I further accept all liability which may be a result of the County of Burned,relying on this information I am ��/7J1 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person t have access to the above described premises at any reasonable time for the purpose inspection. <br /> SIGN HERE <br /> ? 1% G � ee <br /> (signature of owner building comncto.) (date) <br /> ZONING ADMINISTRATOR <br /> O pN0N <br /> TOWNSHIP PERMITS MAY BE REQUIRED sa NO <br /> THIS PERMIT SHA L PIRE OPE YEAR FRO DATE OF ISSU CE <br /> Pefrrml{ `!e '[+' Pt d u� y tor) 0amer 7-96 06 <br />