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Burnett County 7410 County Road K, No. 102, Siren,WI 54572 Office of Zoning Administrator - C <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER t7 �i G �Rr TELEPHONE <br /> PROPERTY ADDRESS ��O-y N, /v7U�YPr✓ L4A� L(� IO <br /> LEGAL DESCRIPTION <br /> 0 <br /> 1-bi 2-38-17-j&-,5os-ooh -0190oo d -OLOOao <br /> MAILING ADDRESS <br /> U0 ?JAI- � D� <br /> TYPE in PE Family : J P I/ r <br /> Cl❑ Single Family Dwelling Cl Bunkhouse <br /> /Aaessory Structure ❑ 5 Ins Cl Commercial Building =. <br /> Cl Addition ❑ Bunkhouse Filling/Grading CI Commercial Addition a <br /> ❑ Deck ❑ 59.1 Gazebo Cl Camping Unit ❑ Commercial Act. Structure 3 <br /> STRUCTURE/ADDITIONUSE: AGr&tL-THE-FAoT F/L!./w/G �G�Ab/NGT z <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc) <br /> �i� A <br /> BUILDING CONTRACTOR: JlC Lr C <br /> re <br /> n <br /> i <br /> PLOT PLAN ---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. 3V. <br /> ***REQUIRED PLOT PLAN INFORMATION*** " a <br /> Cl 81/2"X 11"SHEET OF PAPER DISTANCE(IN FEET)T0: o <br /> Cl DRAWN TO SCALE OR DISTANCES LABELED O WELL <br /> Cl PROPOSED BUILDING/STRUCTURE LOCATION ❑ SEPTIC TANK&DRAINFIELD <br /> 4Dimensions&Heights ❑ ROAD RIGHT-OF-WAY IF SURVEYED N t jd <br /> ❑ EXISTING BUILDINGS/STRUCTURES(Includes deck, porch, etc.) ->CENTERLINE IF NOT SURVEYED - <br /> -)Dimensions&Heights O ALL PROPERTY LINES <br /> ❑ NORTH ARROW O ORDINARY HIGH WATER MARK <br /> T - y <br /> NOTE: euiltling/sUucture location must be staked for onverificationEl ALL WETLAND AREAS <br /> tipn when needed. <br /> E <br /> ��JJ^ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: �11_ <br /> • Removal or cutting trees and vegetation is areMRed along shoreline IIVn Lam. lJ t•� I }— y <br /> • No structures(includidi ng retafirally ining walls,etc.)are allowed unless spedpermitt <br /> • No filling,grading,or shore land alterations are allowed unless spedfca11 permitted SEP 4 2014 <br /> • Drweway,must meet wiuth requirements within 60 days of permit Q <br /> • Accessary structure/garage permits allow for private residential storage only <br /> "Not to be used for human habitation or rental storage'- BURNETT COUNTY — Q <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to thnowledge and CJ <br /> belief it is true,correct and complete. 1 acknowledge Mat 1 am responsible for Me detail and accuracy of all information contained In <br /> this application(including any accompanying schedule)and I further declare timet I recognise Mat this information provided will be <br /> relied clone by Me county of Burner Wisconsin in determining whether to issue a permit I further accept all liability Mat may be a <br /> result of the county of Burnett relying on this information lam Providing In this application. I agree to Permit county officials charged `< <br /> with administrating county ordinances or other authorized persons to have access to the alum"escribed premises at any reasonable <br /> time for Me purpose of inspection. <br /> �, > nnnna � <br /> --ADDITIONAL CONDITIONS— H 3 ii Ti <br /> /N/ <br /> NO <br /> �4p "A /(7 Pa'Of/s-vm Gd hlY/� /A�(gS'GICJ UnfI�GS ��l�at� n' _ "•'a ,�„ <br /> l7u �° ns�s Af! wr11 lu 4dh•P/&F41 �y LArc� tt�,Du fo �u+ter m ,rr�ak2y R ^ o w s <br /> 'a <br /> OWNER'S SIGNATURE 9-y-/y _ g; <br /> / r (dace) <br /> ZONING OFFICIAL U,ril 9— `/,/y = _ m on <br /> (date) _ : it c : F a <br /> --TOWN/UDC PERMITS MAYBE REQUIRED **THIS PERMIT SMALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE - - <br /> You are responsible fa complying with state and federal laws concerning construction near or on wetlands, lakes, and streams. _ <br /> Wetlands Mat are not associated with open water can be difficult to identify. Failure to comply may result in removal or modifcaUon <br /> of construction Mat violates the law or other penalties or costs. For more information visit Me Department of Natural Resources - 0 8 <br /> wetlands identificabon web Page or contact a Department of Natural Resources service center. <br />