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r <br /> Burnett County 7410 County Road K,No. 102, Siren,WE 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS = — 70 <br /> r+ <br /> OWNER / TELEPHONE - — <br /> 75E'"n ,Ief// f�a et5 7r5 -4A 7-�73`f/PROPERTY ADDRESS <br /> /0Y5t_ R 70 Sfrcr, Wz .5 ld 7-D-- —] o <br /> LEGAL DESCRIPTION 5 f�r3�/R v 7W hew wG E)< N50 Rd, ups C /b Rd5 N 'i9r1 <br /> u'( W f3 i7ds s. Ez Nw� Drsc <FS//t fib ,. .SLy/syt n <br /> MAILING ADDRESS r d 5 <br /> TYPE OF PERMIT(S): <br /> ❑ Single Family Dwelling 0 Garage/Accessory Structure ❑ Stairs ❑ Commercial Building 5 <br /> ❑Addition ❑ Bunkhouse ❑ Filling/Grading ❑ Commercial Addition t <br /> 0 Deck U 59.6922(ly)Gazebo 0 Camping Unit ❑ Commercial Acc. Structure 9 <br /> STRUCTURDDRION E; N.yJ�.r�V F,7'/,"n /Irak �4 L� vX�i� !li/�P17e'SN 0�/ z <br /> \ X/O (Ho e/Cabin;Commercia Business; Bedroom; Deck;etc.) <br /> z <br /> BUILDING CONTRACTOR: <br /> 'LOT PLAN ---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> M <br /> ***REQUIRED PLOT PLAN INFORMATION*** <br /> ❑ BYz"X 11"SHEET OF PAPER DISTANCE(IN FEET)TO' o <br /> ❑ DRAWN TO SCALE OR DISTANCES LABELED Cl WELL <br /> 0 PROPOSED BUILDING STRUCTURE LOCATION ❑ v <br /> / SEPTIC TANK&DRAINFIELD ( <br /> 4Dimensions&Heights Cl ROAD RIGHT-OF-WAY IF SURVEYEDJj <br /> i <br /> ❑ EXISTING BUILDINGS/STRUCTURES(Includes deck, porch, etc.) ->CENTERUNE IF NOT SURVEYED <br /> Dimensions&Heights ❑ ALL PROPERTY LINES <br /> ❑ NORTH ARROW ❑ ORDINARY HIGH WATER MARK 5. <br /> ❑ ALL WETLAND AREAS <br /> NOTE: Building/structure location must be staked for onsite verification when needed. <br /> 1 7 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: _ <br /> • Removal or cutting of bees and vegetation is restricted along shoreline <br /> • No structures(including retaining walls,etc.)are allowed unless specifically permitted <br /> • No filling,grading,or shore land alterations are allowed unless specifically permitted <br /> • Driveway must meet width requirements within 60 days of permit — d <br /> • Accessory structure/garage permits allow for private residential storage only <br /> •*Not to be used for human habitation or rental storage"' <br /> F <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge and <br /> belief it ie bud;carred amu compietm I nying sc edu nand am responsible fur ee Irbil gnu athaacy of as motion provided <br /> will <br /> this applicationoby <br /> (including any accompanying n in dee)and I further whether to mss that I recognize that this information provided will be <br /> relied upon by Me County of burnett Wisconsin in atop I am vllinto this¢a permit. I further accept all liability that may re a <br /> resuwith administrating <br /> Me County g of my ett relyingordinance on this information)am providing access <br /> torotion, I agree to ribed promises <br /> any reasonable le <br /> time for me purpose <br /> county ordinances or other aueodze0 arsons to have atcehi to one above-described premises at any reawnable <br /> time for me purpose of inspection. (-r <br /> n <br /> ---ADDITIONAL CONDITIONS--- * "* • <br /> � rvr6 � � 3 � 'oa <br /> EC M <br /> HQ�K`. 6E /!/IcQ'TFi�EfI2E9/S[�P� D LL,I�J�� VED s <br /> JUL 11 2014 <br /> . Ag'^� 8,a3 <br /> BURNETTCOUNTY n Es000so : <br /> OWNER'S SIGNATURE��n2v-c•-Cti /Vz' - . <br /> 7/1 o o <br /> (aommte)W`C x c = [' <br /> ZONING OFFICIAL <br /> o � <br /> '(date c K <br /> **TOWN/UDC PERMITS MAY BE REQUIRED **THIS PERMIT SMALL E%PIRE ONE YEAR FROM DATE <br /> OF ISSUANCE <br /> You are responsible for complying with state and federal laws Conceming construction near or on wetlands, lakes, and streams. J — <br /> Wedands 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 penaltes or costs. For more information vivt the Department of Natural Resources — <br /> wedands identhcatpn web page or contact a Department of Natural Resources service center. <br />