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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 /> - � a <br /> OWNER vn��/ ^ ,)v TELEPHONE - 0 <br /> PROPERTY/ADDUSSS/C / V /7 ^ 1 <br /> Lf DAN�3JPj/ wig. sy�3a <br /> ��q�i9 <br /> LEG E RIEIIONT 20 <br /> -0 <br /> Sa�/J /�i0/V�f'/61/l L"?T"� �-sna�. a��u)�zo <br /> MAILING ADDRE55 �� yyy tl �Al SY/�/iv/l5rL <br /> TYPE OF PERMITS): <br /> ❑ Single Family Dwelling ❑ Garage/Accessory Structure El Stairs C] Commercial Building r/�\ <br /> EI Addition Cl Bunkhouse ❑ Filling/Grading ❑ Commercial Addition Q <br /> ,�y'pq�eCly�� ❑ 59.692(ly)Gazebo ❑ Camping Unit ❑ Commercial Am Structure - <br /> J�y/` <br /> STRUCTURE/ADDTTTON USE: beck_z <br /> / <br /> A /(Home,�abim Commeetc.)al Business; Bedroom; Deck;etc <br /> WILDING CONTRACTOR: /920.4 � y &J ,n <br /> r <br /> PLOT PLAN ---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. � z_ <br /> "**REQUIRED PLOT PLAN INFORMATION**' m IP <br /> 81/x"X 11"SHEET OF PAPER DISTANCE IIN FEETI TO, li'—moi <br /> DRAWN TO SCALE OR DISTANCES LABELED WELL + <br /> PROPOSED BUILDING/STRUCTURE LOCATION SEPTIC TANK&DRAINFIELD - <br /> 4Dimensions&Heights ROAD RIGHT-OF-WAY IF SURVEYED 111111---1 <br /> ❑ EXISTING BUILDINGS/STRUCTURES(Includes deck, porch, etc.) `1 -)CENTERLINE IF NOT SURVEYED a I riff <br /> 4Dimensions&Heights ALL PROPERTY LINES q N I <br /> ❑ NORTH ARROW / ORDINARY HIGH WATER MARK <br /> Cl ALL WETLAND AREAS p <br /> NOTE: Building/structure location must be slaked for onsite verification when needed. °s � <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: <br /> • Removal or Ntting of trees and vegetabon is restricted along shoreline W <br /> • No structures(including retaining walls,etc.)are allowed unless specifically permitted Wit\ <br /> • No filling,grading,or shore land alterations are allowed unless specifically permitted <br /> • Dnveway must meet width requirements wiMin 60 days of permitIYCe$j2+— <br /> • Accessory structure/garage peri its allow for private residential storage only <br /> *-Not to be used for human habitation or rental storage** `= <br /> IA <br /> I declare that this application tndin rete. a n schedule responsible <br /> leen examined 6 me aura to of /ert r m on con a a aura <br /> (including any a¢omWnYi 9 ) Y Y 9 1_ <br /> this application it is true,correct aura complete. I ackn ulsecle Mat I If rther declafor Me detail and a¢urary of all information ided will in D <br /> Miz d u,, nyhe county any accumW Wisconsin <br /> nq n in dee)and I further r to is e a I recognize that this information y Met <br /> will be <br /> relied upon by un county a Burnett Wisconsin in determining rovMer in issue a permit I Iurtler accent all liability Mat may re a <br /> resuwith administrating <br /> the county of aumett relmance on this infomutizedon am providing in access is application.tion. t agree to Permit o ices at any re sonable £ <br /> with for Mes purpose <br /> county ordinances z or abler authorized persons to have access to Me aboveraescriled premises at any reasonable <br /> time for Me purpose o/inspection. <br /> ppp �1I11�1p. = r inn> do � <br /> ---ADDITIONAL CONDITIONS--- D I} V It- D .,^r rn $ 3 3 3 <br /> JUL -72014 <br /> BURNETT COUNTY JDa > 6= < <br /> ZO�/NING � s 5�_ 4 <br /> OWNER'S SIGNATURE // lG•t/L C�//7/L ' / <br /> / tome) <br /> ZONING OFFICIAL T 7-A/ <br /> (data) k ? „ a <br /> '*TOWN/UDC PERMITS MAYBE REQUIRED '*THIS PERMTT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE -You are responsible for complying with state and federal laws concerning construction near or on wetlands, lakes, and streams. <br /> Wetlands Nat are not associated with open water can be difficult to identify. Failure to comply may result in removal or modifcation <br /> of construction that violates the law or other penalties or costs. For more information visit me Department of Natural Resources - <br /> wetlands identification web page or contact a Department of Natural Resources service center. - <br /> o�c <br />