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Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS = <br /> TELEPHONE < <br /> OWNE> -� �R •� -79t-S37a CSL//� <br /> PROPER tt ADDRESS UO t `786 -- 3!9% eh ldscj <br /> LEGAL DEBCRIPRON 1 /�9 l7i)LI ulf�ezT n 1 m <br /> .. n i � ` .z Nal� �GW (rD¢ �Ir LLFl. Lor 7• I ' \ <br /> 'd•386GPt <br /> MAIUNGADDREss �ntrC GT L✓z/ Six.�7Jy yvi s'z/66y <br /> TYPE OF PERMITS): <br /> Ell Single Family Dwelling 0 Garage/Accessory Structure 0 Stairs 0 Commercial Building <br /> Addition 0 Bunkhouse 0 Filling/Grading 0 Commercial Addition .a <br /> 0 Deck 0 59.692(Iv)Gazebo /0 Camping Unit 0 Commercial Ace Structure 3 <br /> STRUCTURE/ADDITION USE: C ,,✓ <br /> (Home/Cab'm;Commemial Business; Rmmbfi;Deck;etc.) /. <br /> BUILDING CONTRACTOR: b, cle-le <br /> r r \ <br /> PLOT PLAN---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. R <br /> _ O <br /> ***REQUIRED PLOT PLAN INFORMATION*** , <br /> 7 Hof X 11"SHEET OF PAPER DISTANCE(IN FEET)TO' C <br /> G DRAWN TO SCALE OR DISTANCES LABELED Er WELL <br /> LK PROPOSED BUILDING/STRUCTURE LOCATION EK SEPTIC TANK&DRAINFIELD <br /> 4Dimensions&Heights -0' ROAD RIGHT-OF-WAY IF SURVEYED 1 <br /> Ef EXISTING BUILDINGS/STRUCTURES(Includes deck, porch,etc.) CENTERLINE IF NOT SURVEYED �- <br /> -)Dimensions&Heights � ALL PROPERTY LINES o <br /> 'LI NORTH ARROW ORDINARY HIGH WATER MARK - <br /> Z- ALLWETLANDAREAS �(�� <br /> NOTE: Building/stmcture location must be staked for onsite verification when needed. /� p pry nD1 I� �///������ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: �11 ���"111� "��yy-3__ L[ <br /> • Removal or cutting of trees and vegetation is restricted along shoreline Ill J•• U ILr� -t— 1 <br /> • No structures(including retaining walls,etc.)are allowed unless specifically permi l <br /> No filling,grading,or shore land alternerms are allowed unless specifically pemid, - <br /> • Driveway must meet width requirements within 60 days of permit JAN 3 0 2015 r <br /> • Accessory structure/garage permits allow for private residential storage only <br /> Not to be used for human habitation or rental storage'" _ <br /> I declare that this application(including any accompanying schedule)has been examined by-mOf <br /> belier it is time,correct and complete. Iacknowledge mat l am responsible for the detail and accuracy 4 WINIl{pL3tion contained in I\' <br /> this application(including any accompanying schedule)and 1 further declare that 1 recognize that this information provided will be <br /> relied upon by Me county a Bumett Wisconsin in determining whether to issue a permit. 1 further accept all liability that may be a $ <br /> result of Me County of Bumett relying on this information 1 am 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 above-described premises at any reasonable <br /> time for the purpose of inspection. <br /> / T 333 <br /> ADDITIONAL CONDITIONS--/ / � e l - M L Q/I 5ol.Ff <br /> �e Ne 8 6e T G P1 K <br /> Q 1 I = > <br /> �L9o�SasQab PAro�Q <nf bTNMW 'tdy ,6/so�S, <br /> �f f <br /> ,I-O <br /> QtII,y / )(P be aPProved by 6/301 " o s m <br /> ( P o = A <br /> S/IOP�I[AG H"I F7T O,M1 I4y1 '«„a3 <br /> OWNER'S SIGNATURE c a m C s _ tin <br /> e) aF . —. m <br /> on <br /> ZONING OFFICIAL .✓� /Z z0/S N = <br /> as e) <br /> **TOWN/UDC PERMITS MAYBE REQUIRED "MIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> You are responsible for complying with state and federal laws concerning construction near or on wetlands, lakes, and streams. 8 <br /> Wetlands that are not associated with open water can be difficult to Identify.Failure to comply may result in removal or modiflcafon <br /> of cons[mmon Mat violates the law or other penalties or casts. For more informafon visit the Department of NaNral Resources, o 0 0 <br /> wetlands idenbficabon web page or contact a Department of Natural Resources service center. <br />