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Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of,Zoning Administrator C <br /> APPLICATION FOR LAND USE PERMITS - <br /> OWNER TELEPHONE <br /> DEa2AJ1s d Lpec 4 r J Pry 3-11 - 8411 <br /> PROPER TT``((ADDRESS <br /> 261gt S Ja NNte.J LA)C,6 <br /> /LJ C <br /> LEGAL DESCRIPTION <br /> ) <br /> ozo 43z 3og 40o 5 .2-3 14J r-) Rlb •✓ �N <br /> MAILING ADDRESS c, <br /> Z$t9S S.Ob H✓4-J (.}rc' 40 WERS1YVL . r✓1 �v} 843 <br /> TYPE OF PERMIT(S): 5 <br /> ❑ Single Family Dwelling J✓f(Garage/Accessory Structure ❑ Stairs ❑ Commercial Building <br /> ❑ Addition ❑ Bunkhouse ❑ Filling/Grading ❑ Commeroal Addition <br /> ❑ Deck p❑ 59.692(ly)Gazebo LI Camping Unit C3 Commercial Acc.Structure <br /> STRUCTURE/ADDITION USE:_ /&tz- <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: 01Yr/LCR F <br /> 'LOT PLAN ---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. m z <br /> =..REOUIRED PLOT PLAN INFORMATION*** g <br /> 5 BY,"X 11"SHEET OF PAPER DISTANCE(IN FEET)TO; <br /> 0 DRAWN TO SCALE OR DISTANCES LABELED ❑ WELL <br /> ❑ PROPOSED BUILDING/STRUCTURE LOCATION ❑ SEPTIC TANK&DRAINFIELD <br /> 4Dimensions&Heights 54:x ¢o t¢ 1111yd Q1 ROAD RIGHT-OF-WAY IF SURVEYED <br /> ❑ EXISTING BUILDINGS/STRUCTURES(Includes deck, porch, etc.) 4CENTERLINE IF NOT SURVEYED <br /> 4Dimensions& Heights 0 ALL PROPERTY LINES <br /> Sif NORTH ARROW _ ..- ❑ ,ORDINARY HIGH WATER MARK �. <br /> ❑ ALLWETLANDAREAS _ <br /> NOTE: Building/structure location must be staked far onste venfic ham when needed, 3 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ) <br /> • Removal or cutting of trees and vegetation is restricted along shoreline 1 <br /> • No structures(including retaining walls,etc.)are allowetl unless speoNzilly 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 <br /> • Accessory structure/garage permits allow for private residential storage only <br /> Not to be used for human habitation or rental storage"" ❑ {IIZ <br /> I deciare net this a application(including an accompanyingzchedul ha <br /> pP ( I Yge e) s been examined by a and to of best o/my knowledge and <br /> belief it is trop correct and Complete. 1 acknowledge scedge Mat I am responsible fur Me detail and amlreq or all interrelation <br /> ationH ro contained in <br /> this application (including any accompanying scM1edule)and I further declare Nat I recognise that this information provided will be <br /> reified upon by the County or relying <br /> onthis <br /> siin in determining I am whMer In issue a permit'i further adept ail ll o Mat may be a <br /> mauwin ad Me County co eumett relying o r other auth tion l a sons to <br /> ng have this t application. I agrtt to permit county erat any officials chargee Q <br /> win administrating county ordinances or other auModaed persons to have access M Me above-descdhd premises at any reasonaEle <br /> time for the purpose of inspection. <br /> n � > nnnkn6q <br /> --ADDITIONAL CONDITIONS--- <br /> ECERSE <br /> 3 � <br /> U9 <br /> I = > o <br /> JUN 3 0 2014 D q na „ t <br /> "s ' x <br /> BURNETTn n�� s ^ R »o-8 <br /> n /� ��j..��1A,rtv <br /> ` e <br /> OWNER'S SIGNATUREY- ' r ? G� = ooh <br /> n <br /> LA'1Sr O/v r/ ( <br /> ZONING OF <br /> y0P)71 / <br /> "TOWN/UDC PE S MAY BE REQUIRED -*THIS PERMIT SHA PIRE ONE Y R FROM DATE OF ISSUANCE -You are responsible for compMng 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 cases, For more information visit the Department of Natural Resources - - <br /> wetlands idengfication web page or contact a Department of Natural Resources service center. `^ -.8 0 0 0 <br />