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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administratorr <br /> LN C_- <br /> APPLICATION FOR LAND USE PERMITS a <br /> �OWNER TELEPHONE - <br /> �le- ani- (pis �SrntC � �iaH) sv3-nQdG <br /> PROPERTY ADDRESS y <br /> � 1V f;,/ [_,>t> Pc✓ jkln ..n. r.i> syf 4LI <br /> � 1 <br /> LI.E�GAL DESCRIPTION <br /> V'b ( nJl c 4Ie- * SUTA -S�e To u.nrh�a 40N <br /> MAILING ADDRESS I Pl y111 , lV' —'J;ljc�I <br /> TYPE OF PERMIT(S): errF SCOTT <br /> L3 Single Family Dwelling ❑ Garage/Accessory Structure LI Stairs ❑ Commercial Building _ V <br /> Addition ❑ Bunkhouse ❑ Filling/Grading ❑ Commercial Addition .� <br /> ❑ Deck ❑ 59.692(Sv)Gazebo ❑ Camping Unit ❑ Commercial Acc. Structure <br /> 0 <br /> STRUCTURE/ADDITION USE: Deck, <br /> ' U U /Ip IQ6-iM Q,ipa Z <br /> ( ome/Cabin; mmeraal Business; Betlroom;Deck; e[cJ � <br /> ' A <br /> BUILDING CONTRACTOR: 121cma AG r ew O S� <br /> n c1J <br /> PLOT PLAN--- INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. c i G a <br /> ***REQUIRED PLOT PLAN INFORMATION*** <br /> ❑ 816'X 11"SHEET OF PAPER DISTANCE(IN FEET)T0: (} of <br /> ❑ DRAWN TO SCALE OR DISTANCES LABELED ❑ WELL <br /> ❑ PROPOSED BUILDING/STRUCTURE LOCATION ❑ SEPTIC TANK&DRAINFIELD <br /> 4Dimensions&Heights ❑ ROAD RIGHT-OF-WAY IF SURVEYED ? -C <br /> ❑ EXISTING BUILDINGS/STRUCTURES(Includes deck, porch,etc.) 4CENTERLINE IF NOT SURVEYED 1 <br /> 4Dimensions&Heights ❑ ALL PROPERTY LINES o <br /> ❑ NORTH ARROW ❑ ORDINARY HIGH WATER MARK <br /> ❑ ALL WETLAND AREAS <br /> NOTE: Building/structure location must be staked for onsite verification when needed. D F <br /> LT E I E <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: D 1 ,� <br /> • Removal or cutting di trees and vegetation is are antes along shoreline SEP 1.1 2014 <br /> • No structures <br /> gra ing,or shore <br /> retaining walls,etc.)are allowed unless specifically permitte IFOI� <br /> • No filling,grading,or shore[antl alterations are 60 days <br /> unless specifically permitted <br /> • Driveway must meet arab)requirements for private <br /> days of permit BURN u` <br /> • Accessory structure/garage permits allow far private residendal storage only ETT COUNTY Z <br /> n <br /> **Not tobe used for human habitation or rental storage** ZONING - <br /> n schedule)has been examined D me and to Me best of m knowledge and Irby <br /> I tledati true,correcandapplication(including any accompanying that <br /> ) Y Y contained <br /> belief it is hue,COrrM antl ny accom I acknowledge Mat 1 am responsible for Ne tl rec antl aceuraq of all informationidedillin <br /> this application(including any accompanying schedule)and I further declare that I recognize that this information provided will be <br /> result upon by the countyne Burnett Wisconsin in determining lam wovidin to issue a permit. I further accept all liability that may r a <br /> result of thedmini County of Buy onfintt nce on this information[am ons to have thisaccess <br /> to <br /> a abo agree rated T i[cou atofficials sonable f <br /> with administrating Purpose <br /> county a tion. s or other authorized persons M have access[o[M1e above-tleuribetl premises a[any reasonable <br /> time for[M1e purpose of inspection. - <br /> nA > nrecn6$ <br /> --ADDITIONAL CONDITIONS-- <br /> _ `r w <br /> 12 2 <br /> azo <br /> OWNER'S SIGNATURE ZZ 11 2v(`I A d co ov - � <br /> as _ <br /> ZONING OFFICIAL )ZO/ ` m <br /> --TOWN/UDC PERMITS MAYBE REQUIRED **THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE _You are responsible for complying with state and federal laws concerning construction near or on wetlands, lakes, and streams '€ <br /> Wetlands that are not associated with open water can be difficult to identify. Failure to comply may result in removal or modification <br /> of construction that violates Me law or other penalties or costs. For more information visit Me Department of Natural Resources 22 <br /> u o <br /> wetlands identification web page or contact a Department of Natural Resources service center. — <br />