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Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administrator _ ro <br /> APPLICATION FOR LAND USE P R75 _Z; 2)S— <br /> S = <br /> ��I4) S2010 a 9 <br /> OWNER -y-% Y /%l t ( (O I TELEPHONE/ I II 4q 3 <br /> PROPERTY ADDRESS L61—K-c Z� P, <br /> _ t <br /> LEGAL DESCRIPTION <br /> C� I ` n <br /> MAILING ADDRESS ^\' C-fin /t 1 -T N)2 non vont '. 1 01 5:1:151 <br /> TYPE in Pe Family <br /> S):Y' K(A 9 <br /> ❑Single Family Dwelling ❑Garage/Accessory Structure El Stairs <br /> ❑ Commercial Building <br /> ❑ Addition ❑ Bunkhouse ❑ Filling/Grading ❑Commercial Addition <br /> ❑ Deck ❑ 59.692(iv)Gazebo / Cgam�ping(/Unit ❑Commercial Am.Structure r <br /> STRUCTURE/ADDTDON USE: <br /> (How me%titin;Cgmmertlal Business;Bedroom; Deric;etc.) p <br /> BUILDING CONTRACTOR: <br /> m <br /> r S � <br /> PLOT PLAN---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. _ <br /> m <br /> ***REOUIRED PLOT PLAN INFORMATION*** <br /> ❑ 81h"X 11"SHEET OF PAPER DISTANCE(IN FEET)TO: <br /> ❑ DRAWN TO SCALE OR DISTANCES LABELED ❑ WELL <br /> O PROPOSED BUILDING/STRUCTURE LOCATION <br /> Cl SEPTIC TANK&DRAINFIELD t� <br /> Dimensions&Heights O ROAD RIGHT-OF-WAY IF SURVEYED � l <br /> I <br /> ❑. EXISTING BUILDINGS/STRUCTURES(Includes deck, porch,etc.) CENTERLINE IF NOT SURVEYED <br /> Dimensions&Heights 13ALL PROPERTY LINES N ) <br /> ❑ NORTH ARROW ❑ ORDINARY HIGH WATER MARK <br /> ❑ ALL WETLAND AREAS <br /> NOTE: Building/structure location must be staked for onsite verification when needed. /LV <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 1 -I <br /> • Removal0,cutting of trees and vegetation is restricted along shoreline <br /> No structures(including retorting 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 re9uirements within 60 days of permit Q <br /> • AwessorY structure/garage hermits allow for private residential storage only n Z <br /> **Not to be used(or human habitation or rental storage^ a <br /> 1 declare Mal this appllea ion onelum"any armmpanyin,.h uw)has been uamlred by me and to th best of my krowkdpe and <br /> —�beliaf I[is lrw.cvreR all mmple[eT I xk ,ajge[ It I am rgponame for Me detail all oaa,/.f all iMwmation mMainea m <br /> this aFplp'aBml(Including arty acrampanyilg schedule)all 1 fuller declare Mat I moognbe Mrt[hN inranmlion provided will be r 1 <br /> relied upon by the canary or Burnett Wi.mm In determining whether m issue a permN. 1 further at¢pt all liability Bal may be a <br /> mouls ohms <br /> nom mom ne county or rannart enim on this indmonatian IMe- <br /> loo to Want onalm <br /> um along gamy wdlwnces or other havm <br /> permna W e moess ted above-dctaibed prem"oes aamaiream mbllee <br /> time for Me purpose or inspa.Hon. *1 D n r n C:a 4 <br /> NsAAno = <br /> ---ADDIITONAL CONDITIONS--- ��n�p2 � aIN <br /> �elm nJ has M6U7 jecE SLh cep /,87Fri <br /> �Cn pYr /y, be Te,, o , L 28 2014 D o c' -o A <br /> n BURNE 3 s o 0 o a o <br /> OWNER'S SIGNATURE //(/Lon <br /> ZONING OFFICIAL ^'- 7 30 <br /> (d ) R c a <br /> **TOW N/UDC PERMITS MAV BE REQUIRED *•THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> You are responsible for wmplying with state and federal laws concerning construction near or on wetlands, lakes, and streams 8 <br /> Wetlands that are not associated with open water can he difficult to identify.Failure to comply may resot in removal or em ndimboo _ <br /> of wnstruaion that violates Be law or other penalties or costs. For more information visit Be Department a Natural Resources <br /> wetlands identification web Page or contact a Departrnent of Natural Resources service center. <br />