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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator Z. 9 G <br /> APPLICATION FOR LAND USE PERMITS c <br /> OWNER ; 0 TELEPHONE <br /> PROPERTY ADDRESS r-/— <br /> LEGAL DESCRIPTION - <br /> of �X C°S/11 Ila/ /7� ( �3y Sc�3S T3v� Rlbw <br /> MAILING ADDRESS = 1 <br /> tifrn��_C(Jr�4ei L1S S�1493 <br /> TYPE OF PERMIT(S): � <br /> U Single Family Dwelling ❑ Garage/Accessory Structure ❑ Stairs Cl Commercial Building <br /> ❑ Addihon O Bunkhouse ❑ Filling/Grading U Commercial Addition .� <br /> 21 Deck ❑ 519.692(Sv)Gazeta ❑ Camping Unit ❑ Commercial Acc. Structure <br /> STRUCTURE/ADDITION USE: C+ � IS Z <br /> r(Home/Cabin;Commercial Business; Bedroom; Deck;etc. 93 <br /> \ J <br /> BUILDING CONTRACTOR: ;l 1. Il IC�CA ( Ksi��S NG K'S rMdn /liiCN�l T 'I�I <br /> V T rrVJJ1 <br /> n v <br /> PLOT PLAN ---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. " <br /> '**REOUIRED PLOT PLAN INFORMATION*** <br /> ❑ 811/x"X 11"SHEET OF PAPER DISTANCE(IN FEET)T0: (�7 <br /> ❑ DRAWN TO SCALE OR DISTANCES LABELED U WELL = ` <br /> ❑ PROPOSED BUILDING/STRUCTURE LOCATION ❑ SEPTIC TANK&DRAINFIELD _ <br /> 4Dimensions&Heights ❑ ROAD RIGHT-OF-WAY IF SURVEYED <br /> Cl EXISTING BUILDINGS/STRUCTURES(Includes deck, porch, etc.) 4CENTERLINE IF NOT SURVEYED <br /> 413imensions&Heights ❑ ALL PROPERTY LINES <br /> Cl NORTH ARROW ❑ ORDINARY HIGH WATER MARK <br /> U ALL WETLAND AREAS <br /> NOTE: Building/structure location must be staked for onsite verfic ton when needed. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: t N� <br /> • Removal or cutting of trees and vegetation is restricted along shoreline <br /> • No structures(inducting retaining walls,etc.)are allowed unless spedfically permitted (fia <br /> • No filling,grading,or shore land alterations are allowed unless specifically permitted <br /> • Driveway must meet width requirements within 60 days of permit 1; 1 <br /> • Accessory structure/garage permits allow for private residential storage only <br /> -Not to be used for human habitation or rental storage•' !' <br /> 1 declare Mat this application(including an accompanying schedule has been examined D me and to Me best of m knowledge and <br /> DD ( 9 Y ge that <br /> 9 ) Y Y i <br /> belief itis true,correct and complete. I yi n schedule) <br /> Mat I am responsible lot the detail and a that accuracy of all information <br /> mation oo provided! <br /> will <br /> he <br /> this apPlimtlon(including any accompanying schedule)and I further declare that I recognize that this information provldcd will be <br /> result upon by the County Barnett aurnett Wisconsin in determining wbeMer in issue a permit [hrreer adept all liability Mat may r e a <br /> ged <br /> with o/Meeountyating ofuntyordinance on other uthorioml persons <br /> to haveg in access application. ve-deatapermiemunt at any <br /> ssonable < <br /> with far administrating county ordinances or other authodze0 permns[o have access to the above-tleudbee premises at any reasonable <br /> purpo <br /> e of <br /> time DITTO AL CONDITIONS- <br /> NS- ECCE SE <br /> 1�It�`1�Ir l.`l.'.'.'ILlyr� VU �l n n e o 0 o d p <br /> ,fob Siei I Tec <br /> ---ADDITIONAL CONDITIONS--- F w 5 3 = S 5 = <br /> a5o35 Aylen v Ro cl a u <br /> JUN 23 2014 GiantSlx � ,w� �ygvp <br /> BURNETTCOUNTY - <br /> ZONING _ a <br /> OWNER'S SIGNATURE (QI <br /> ZONING OFFICIAL �Ll = 3 F J z t <br /> (data) = Ic : _ <br /> "TOWN/UDC PE S MAY BE REQUIRED "THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ' -You are responsible for cemplying 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 mat violates me law or other penalties or costs. For more information visit the Department of Natural Resources <br /> ti <br /> wetlands identification web Page or contact a Department of Natural Resources service center. rr <br />