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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator 3 C <br /> APPLICATION FOR LAND USE PERMITS - <br /> OWNER TELEPHONE o . <br /> _Daui>zB. -�RA o"A_xt_NoFFMatu �f • av5 •asyg <br /> PROPERTY ADDRESS <br /> act 13.7-_�0_•_2E1 �leory w I 048,30— <br /> LEGAL DESCRIPTION <br /> _!oc✓Al at Seo!/ S���r�4— f 40 t�h'l4 1W GOU( LOT l � 1 <br /> MAILING ADDRESS / OI� / <br /> /// hlW r_,("`itI <br /> TYPE OF PERMIT(S): I <br /> U Single Family Dwelling Garage/Accessory Structure U Stairs <br /> El Commercial Building <br /> U Addition 0 Bunkhouse U Filling/Grading U Commercial Addition a <br /> U Deck U 59.692(ly) Gazebo U Camping Unit 0 Commercial Acc. Structure 3 <br /> STRUCTURE/ADDRION USE �1lJr _��( = <br /> ( e/Cabin;Commercial Business; Bedroom; Deck;etc.) j, <br /> k z <br /> BUILDING CONTRACTOR:_jPy'(-()_.Q b'QNG O <br /> PLOT PLAN ---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. � z <br /> r _ s <br /> ***REOUIRED PLOT PLAN INFORMATION*** m <br /> 39 8'/x"% 11"SHEET OF PAPER DISTANCE(IN FEET)TO, o SJ <br /> '�- DRAWN TO SCALE OR DISTANCES LABELED �[ WELL <br /> pl PROPOSED BUILDING/STRUCTURE LOCATION AT SEPTIC TANK&DRAINFIELD _ S <br /> 4Dimensions& Heights Ed ROAD RIGHT-OF-WAY IF SURVEYED N <br /> EXISTING BUILDINGS/STRUCTURES(Includes deck, porch, etc.) -)CENTERLINE IF NOT SURVEYED <br /> -)Dimensions&Heights J!( ALL PROPERTY LINES - <br /> NORTH ARROWa <br /> f$ ORDINARY HIGH WATER MARK = vl <br /> I <br /> ALL WETLAND AREAS -a <br /> NOTE: Building/structure location must be staked for onsite verification when needed. M I °s <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: D [ECE �•J E _ <br /> • Removal or coming of trees and vegetabon is resMcted along shoreline <br /> • No structures(including retaining walls,etc.)are allowed unless specifically per <br /> • No filling,grading,or shore land alterations are allowed unless specifically permi d NOV 3 2014 o <br /> • Driveway must meet width requirements within 60 days of permit <br /> • Accessory structure/garage permits allow for private residential storage only gURNETT COUNTY C <br /> Not to be used ge <br /> for human habitation or rental stora ^ <br /> C <br /> I declare that this application(including a accom n schedule has been examined b m and to h best of m knowledge and <br /> PP ( 9 nY panYi 9 ) Y e the Y 9 <br /> this <br /> it is true,correct and complete. I acknowledge that I am further <br /> responsibleforthe detail and accuracy this <br /> of all informationicepro ided ill in <br /> this applon by (including anyaccompanying Wisconsin <br /> n in dee)and 1 fwheth declare that I recognize that this int all <br /> Bion provided will a <br /> relied upon by Me County of Burnett Wisconsin in determining whether in issue a permit. 1 further accept all liability cis may r a <br /> suit of the County co Burmy or relying on or <br /> information l er providing in this application.ati l agree ri permit county promises <br /> at any officials sonable Q <br /> with far <br /> purpose <br /> county ordinances es or o[M1erau[harized persons to have aaess[otheabove-tleuribad premius atany reasonable <br /> time for the purpose of inspection. <br /> n <br /> a of <br /> ---ADDITIONAL CONDITIONS... m 3 3 3 5 <br /> r <br /> a <br /> 11 / <br /> OWNER'S SIGNATURE ✓IIMaOLTLC_�/{'L.�XM(Q+I�� � yI a <br /> c n " <br /> ZONING OFFICIAL <br /> ® (date) <br /> **TOWN/UDC PERMITS MAYBE REQUIRED **THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE _ ' cr <br /> 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 the law or other Penalties or costs. For more information visit Me Department of Natural Resourcesur <br /> wetlands identification web page or contact a Department of Natural Resources service center. <br />