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r <br /> Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administrator - G <br /> APPLICATION FOR LAND USE PERMITSyr <br /> ((( <br /> OWNER C] _\- (� \ \ TELEPHONE <br /> PROPERTY ADDRESS 4" ,w•\ R'\ ItJ6 1� •�[ <br /> LEGAL DEXRIPRON WC, 3 - 9 <br /> MAILING ADDRESS <br /> TYPE OF PERMIT(S): el• 00 ZD U� IIITTT— �y- <br /> U Single Family Dwelling U Garage/Accessory Structure '$Stairs U Commercial Building = /yV'••) <br /> D Addition U Bunkhouse D Filling/Grading J Commercial Addition .i <br />.•_.._ • Deck ��U� ��59..�69//2�((ly)Gazzeebbotry� D Camping Unit U Commercial Ace Structure - 3 <br /> 5TRUCr1RE/ADDITION USE: NI.UCL.'aAl J I Tl I Rs -— z <br /> ` `Fbane/Cabm;Commercial Business; Bedroom; Deck;etc.) S - <br /> 0. S!� �ZV zoc. z (1) <br /> BUILDING CONTRACTOR: �1 't\�C i.. <br /> - r <br /> PLOT PLAN---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. _ c a <br /> "'REOUIRED PLOT PLAN INFORMATION"' �o C7'( <br /> Cl 8'h"% 11"SHEET OF PAPER DISTANCE(W FEET)TO � O <br /> U DRAWN TO SCALE OR DISTANCES LABELED U WEILL <br /> D PROPOSED BUILDING/STRUCTURE LOCATION U SEPTIC TANK&DRAINFIELD - I <br /> -)Dimensions&Heights Cl ROAD RIGHT-OF-WAY IF SURVEYED _ <br /> U DUSTING BUILDINGS/STRUCTURES(Includes deck, porch, etc.) -)CENTERLINE IF NOT SURVEYED <br /> 4Dimensions&Heights O ALL PROPERTY LINES - <br /> D NORTH ARROW U O DINARY HIGH <br /> Ls++LWATER MARK B. <br /> Cl <br /> �u1V/Ire W <br /> NOTE: Building/structure location must be staked/or onsite verification when needed. LLLJJJ LLLL�7 D <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: t , <br /> • Removal or cutting of trees and vegetation is restricted along shoreline 91 SEP 22 2014 <br /> • No structures(inducing retaining walls,etc.)are allow dl unless spedfcally perim <br /> • No filling,grading,or shore lsrM alterations are allowed unless spetifietily permiRed <br /> • Driveway must meet width requirements within SD days of permit BURNETT COUNTY : --Z) <br /> • Accessory structure/garage pemli[s allow for private residential storage only ZONING t <br /> "Nat to he used for human habitation or rental storage" <br /> z C7 <br /> 1 Uttlart tlet MIs application(including any accompanying¢bubble)has been examineE by me and to the b!rt of my knowledge and (� <br /> belief I[is We,correct and complete. I acknowledge that I am responsible forme lend and amrary of all Information mntaband in - <br /> MIs application(Including any accompanying achubule)and I further declare that I recognize that this Information provided will be - -- <br /> rcIIM upon by Me Counts of perfect Wisconsin In determining whether to Issue a permit I further accept all liability Mat may be a <br /> reveller..County of Bumen relying on this Information I am providing In this application. I agree ropermit counry ottldals charged <br /> with adminls un county oremiewes or other autlmmedf Mucams to have access to Me abeve-descrlbub premises at any reasonable <br /> time for the purpose of Inspection. <br /> C.`C <br /> ---ADOIITONAL CONDITIONS-- r u n a 3 F.F. - <br /> 2 SNRLL BE 2Nc A/SQZG LIouSLY Go(-0R6 D� n�= >o �- <br /> 3 AJo cAAtoPZES oR Roo Fs, �..a-'' �., <br /> y/ SNAIL BF SuPP�Ed act � 5 oR F�TY.1.Y.5- = a. 8 gaz <br /> n 8 Y r <br /> OWNER'S SIGNATURE <br /> ZONING OFFICIAL <br /> (d M) <br /> "TOWN/UDC PERMITS MAYBE REQUIRED "THIS PERMIT SHALL EKPIRE ONE YEAR FROM DATE OF ISSUANCE -You are responsible for complying with state and fadeal laws concerning construction near or on wetlands, lakes, and streams. A <br /> Wetlands Mat 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 cents. For more information visit the Department of Natural'Rescurces rs <br /> wetlands idernficaeon web page or contact a Department of Natural Resources service center. <br />