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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator 2 3 C <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER TELEPHONE <br /> 13Rh0 + URWN N1cY�2 �b3-75�-`jD42 y � <br /> PROPERTY ADDRESS <br /> 22668 Sa,.rH ST-t_VE2 LAK£ ✓{0- TSptrev L.�L SYBY� <br /> LEGAL DESCRIPTION Z.7 <br /> '7 (29A VZ( POI (�#3T1h50X60V DoT Z ) <br /> MAILING ADDRESS 201 in-l" r110d NE 3tAZd6 MA) sstrig _ 1 <br /> TYPE OF PERMIT(S): L, <br /> ❑ Single Family Dwelling ❑ Garage/Accessory Structure Cl Stairs C) Commercial Building y <br /> Cl Addition )Bunkhouse Cl Filling/Grading ❑ Commercial Addition .� <br /> Q Deck CI 59.692(ly)Gazebo CJ Camping Unit ❑ Commercial Ace. Structure _ 3 l-__ <br /> STRUCRIRE/ADDITION USE: G PAI'& L-Jd?N f+TWC11EP BNNK)/pRSEss, <br /> z (Home/Cabin;Commercial BusineBedroom; Deck;etc.) —C <br /> BUILDING CONTRACTOR: I� 1- I t'-YE�C z <br /> -_-LOT PLAN---INCOMPLETE OR ILLEGIBLE PLOTPLANS.WILL BE RETURNED—- -- -- -- - � - -- - --'��— <br /> ***REQUIRED PLOT PLAN INFORMATION*** 8. <br /> 81/z"X It-SHEET OF PAPER DISTANCE(IN FEET TO: b <br /> 51 DRAWN TO SCALE OR DISTANCES LABELED a' WELL — <br /> 9' PROPOSED BUILDING/STRUCTURE LOCATION '3' SEPTIC TANK&DRAINFIELD _ 36 <br /> 4Dlmensions&Heights rtl' ROAD RIGHT-OF-WAY IF SURVEYED <br /> El'EXISTING BUILDINGS/STRUCTURES(Includes deck, porch, etc.) -)CENTERLINE IF NOT SURVEYED <br /> 4Dimensions&Heights O ALL PROPERTY LINES <br /> NORTH ARROW L3'ORDINARY HIGH WATER MARK = <br /> 0' ALL WETLAND AREAS11b 11 I <br /> NOTE: Building/structure location must be staked for onsite verification when needed. 1/1�V 2 `Y v Oj 's <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: D �il ,.���lf51 <br /> • Removal or Cutting of Veer and vegetation is restrictetl along Shoreline VVV L7 D <br /> • No SoUQures(including retaining walls,etc.)are allowed unless specifically permitte <br /> • No filling,grading,or shore land alterations are allowed unless specifically permitted AUG 21 2014 <br /> • Dnveway must meet width requirements within W days of Permit <br /> • Accessory structure/garage permits allow for private residential storage only BURNETT COUNTY z <br /> *Not to be used for human habitation or rental Storage" <br /> z <br /> I declare that this application(including any accompanying schedule)has been examinee by me antl te e e knowledge and ' <br /> belief it is true,correct and complete. I acknowledge Mat I am responsible for the detail and accuracy of all information cvntalned in <br /> „this application (including any accompanying schedule)and I former declare Mat I recognize that this information provided will to <br /> relied upon by the county of Burnett Wisconsin in determining whether to issue a permit I further accept all liability MM may be a <br /> result of the County of Burnett relying on this information i am providing in this application. I agree to permit county oKcials charged <br /> wish administrating worry ordinances or other authorized persons to have access to Me above-described premises at any reasonable <br /> time for the purpose of inspection.— <br /> --ADDITIONAL CONDITIONS--- C an = = a ?G' <br /> > a <br /> n , o <br /> OWNERS SIGNATURE I✓ r� l Vt+- ?0) <br /> (dam E - <br /> ZONING OFFICIAL Y"--- i'•'•"` g Z�� <br /> (d ) e <br /> --TOWN/UDC PERMITS MAYBE REQUIRED **THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE _ <br /> , <br /> You are responsible for Complying with state and federal laws Concerning construction near or on wetlands, lakes, and streams. <br /> - - <br /> Wetlands that are not associated with open water Can be difficult to inertly. 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 /> wetlands dentification web page or contact a Department of Natural Resources Service Center. <br />