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S � <br /> ' Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning'Administrator c� <br /> APPLICATION FOR LAND USE PERMIT63-1-353'5 45 o A <br /> OWNER/, 1 J 1 /L TELEPHONE <br /> ,n7 f), �cr11 4S I1G <br /> PROPERTY ADDRESS /a SOCo�N cl G OC=f'L)2 D q/LV SNI V W-T 6-Clk_t�6 � O <br /> I / <br /> LEGAL DESCRIPTION PN,.S 5, 4 A kc s n 09,,s 4 D-1 <br /> MAILING ADDRESS <br /> O11 S V J <br /> TYPE OF PERMIT(S): <br /> - <br /> ❑ Single Family Dwelling W Garage/Accessory Structure ❑ Stairs ❑ Commercial Building _ <br /> 7 Addition ❑ Bunkhouse Cl Filling/Grading ❑Commercial Addition •� <br /> ❑ Deck ❑ 69.692(ly)Gazeta ❑ Camping Unit ❑Commercial Acc. Structure <br /> STRUCTURE/ADDTRON USE: �1-lLj' - T c <br /> (Home/Cabin;Commercial Burness <br /> ; Bedroom; Deck;etc) <br /> A <br /> BUILDING CONTRACTOR: SF / i- • <br /> n � <br /> — w <br /> PLOT PLAN---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. K _ <br /> _ _ G <br /> ""REQUIRED PLOT PLAN INFORMATION-** <br /> ❑ 89z"X 11"SHEET OF PAPER DISTANCE(IN FEET)TO: <br /> ❑ DRAWN TO SCALE OR DISTANCES LABELED ❑ WELL <br /> ❑ PROPOSED BUILDING/STRUCTURE LOCATION ❑ SEPTIC TANK&DRAINFIELD <br /> 4131mensions&Heights ❑ ROAD RIGHT-OF-WAV IF SURVEYED <br /> ❑ EXISTING BUILDINGS/STRUCTURES(Includes deck, porch,etc.) 4CENTER❑NE IF NOT SURVEYED �2 <br /> 413imensions&Heights ❑ ALL PROPERTY LINES <br /> ❑ NORTH ARROW ❑ ORDINARY HIGH WATER MARK 3. <br /> ❑ ALL WETLAND AREAS -s <br /> NOTE: Building/structure location must be staked for onsite verification when headed. 9 1 <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: t 1 <br /> • Removal or cutting of trees 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 spedfically permitted <br /> • Driveway must meet width regulrements wimin 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— <br /> I declare that this appllatbn(Indudilq any accompanying schedule)has been enmmad by me and to the best of my knowledge and <br /> btlW It la true,cameo and mmphR. I xYnow wipe that I am retpomlble for the dndall and acomi of all Information contained In <br /> this appliotlon(Indmiln,acv axompami np schedule)and I former decom mho I moopn'¢e that thb Information prtyided will be <br /> Irelandmade upon by me not So m Burnwtt on'dus in attend am whether In this a pwmlt. I/uRber avert all RIbnody y mho mat be a <br /> ,ewh gtinema Mb ntyotnayinoorthuIrlfomo lam ns Wing Ina apgioa Iapwe topermn Mw atany HWneed F <br /> vim for Va, am,mm wnnAy'ecdinanar or other authorized persons to have aoom b[he above-UescribM prtmisn at ant reasonable <br /> time for the WTose nf Inpectlon. r, <br /> nnn III111 <br /> —ADDITIONAL CONDITIONS— ECEI\\IIVER , <br /> SWR ^ <br /> 3 .J � ^ <br /> (z c.+k � o� e�!✓AC°2E�C��.�or-a ER,sT/.vb Afe6i Le `�E w c e`_ <br /> (ash-pe Pw- byft /akI- Aan JUL 282014 <br /> A,3 /race, S/ruchve o ere: <br /> a4lk NUS AT BURNETNT�COUNTY s � n«� a m s <br /> OWNER'S SIGNATURE <br /> (date) <br /> ZONING OFFICIAL <br /> (date) <br /> -"OWN/UDC PERMITS MAYBE REQUIRED "THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE - <br /> You are responsible for compMng with state and federal laws concerning consmIction near or on wetlands, lakes, and streams. <br /> Wetlands that are not associated with open water can be dif oAt to identify.Failure he comply may result in removal or modification <br /> of censor Mon that violates me law or other penalties or costs. For more information visit me Department of Natural Resources „•u i3 c o <br /> wetlands identification web page or contact a Department of Natural Resources service center. <br />