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Burnett County 7410 Co. Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. Q <br /> f CT 0 <br /> L, (/ U <br /> OWNER ,TCf f d- Nancy R©bei+son TELEPHONE d s1- q3o- 7So J a C' <br /> v <br /> �G <br /> MAILINGADDRESS lao NOCIOAnd Ave SMlwAfer., MN 5s'0TACD <br /> � o <br /> PROPERTY ADDRESS 7a q 3 F f e M s+r-d QAn 6v(y �✓2 �— <br /> I <br /> LEGAL DESCRIPTION(see tax receipt) l 6 5 �I Fj T yU N- /Z I to w, q <br /> m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE X1 ADDITION ❑ o <br /> TYPE OF PERMIT(S): v <br /> FILLING/GRADING ❑ CAMPING UNIT ❑ SUBDIVISION ❑ a <br /> u <br /> STRUCTURE/ADDITIONUSE: VPorch, <br /> 0 <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) U <br /> BUILDING CONTRACTOR: Tr C,e C0A-!5+(UG+r0l) <br /> CID \ <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR T 3 I" <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. 0 <br /> N <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) 0 0 <br /> T v Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. m A <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> NORTH(N). y 3 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m �r� <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. <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. <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. I ' <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN o <br /> NEEDED. ° <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: 1 <br /> O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT pJ <br /> ISSUANCE. I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. n ` <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY N <br /> PERMITTED. �7 <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER `+ <br /> SETBACK AREA. <br /> 5. <br /> m min . -0DQ v '0. <br /> 6. m 3 E. m xn2. � <br /> -o � C0 `0o` � 3 <br /> Z O <br /> 7. o -nom : <br /> m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my G>c C <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m in <br /> n m <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m m 0 :. my <br /> that this information I am providing will be relied 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 Burnett relying on this information I am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. CID <br /> COo <br /> CD <br /> SIGN HERE I o/oz.�D;L— Q <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR �� i fyl /(I�/1 O . . . . �N <br /> N, N (T N N 00 <br /> V (PO (T (TOO <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />