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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> r <br /> N 0 <br /> ,/ CD <br /> N <br /> OWNER PAUL � , /1iJCKL TELEPHONE (p 5 — *16*- 7a�S n <br /> o <br /> L'RESS g0a o 01 00+11 Sf IV \C <br /> F01eEsT LAKE, MN 5"5005 � <br /> HOME ADD <br /> n / I <br /> EMERGENCY/FIRE NUMBER 5cGO7�4 oZ 8 7 ROAD NAME <br /> SG aO-a3 V036 P 767- Sao/?yc%f/$z w [� �J <br /> LEGAL DESCRIPTION (see tax receipt) V � a-Y6-iso-as o 0-52900 &L Ga 4t 7- rn <br /> CD <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION X PRIVY ❑ C (n o <br /> TYPE OF PERMIT(S): a <br /> Cr <br /> FILLING/GRADING ❑ CAMPI GSUBDIVISION ❑ o: <br /> 5. <br /> STRUCTURE/ADDITION USE: Gab/I7 uoyy�s 0 <br /> U T <br /> (H me/Cabin; Commercial Business; Bedroom; Deck;etc.) rn <br /> U lJ <br /> BUILDING CONTRACTOR: SPzT <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> n a <br /> -n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. n m M <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> 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 Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <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. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT,ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 ) <br /> MUST BE SIGNED AND DATED BY THE OWNER. o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN <br /> NEEDED. 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> d <br /> CONDITIONS OF PERMI I ( n <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT v� <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SET ACK AREA. /f /� /� �^ /l <br /> 5. o ��/7/ ,�`G�r �...._ (�� S�l/}//-�. /�/ ',n2�-l�Jj �Y�J S�l( /� x vM. 0 r i�oi O � O � <br /> CL m <br /> 6. 1!1 Y r IG'f�G' VI L i''"� /� �, J �'`�' v m c m F o ' 3 <br /> % <br /> �/ (J �j� On <br /> 7. a � . : y �� <br /> i o - rn <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my rj c m <br /> 10 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 0 C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <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 m <br /> authorized person to have access to the above described premisfor the purpose of inspection. <br /> SIGN HERE <br /> (signature of owner or building contractor) JUN 2UO2 (date) <br /> ZONING ADMINISTRATOR /m 1 1�I L uL <br /> � cncn sw an <br /> BURNETT �1NTY y9/9- CA C> N <br /> TOWNSHIP PERMITS MAY BE F 0 0 0 0 <br />