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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> P/ LICATION FOR LAND USE PERMITS <br /> �I <br /> f TELEPHONE <br /> OWNER <br /> Tr M & k_.�_lez- /cE - 7s3 <br /> PROPERTY ADDRESS <br /> I 5o �kh 6 _ 1I Tyr <br /> LEGAL DESCRIPTION <br /> +ff <br /> MAILING ADDRESS 37a� l / (\J- r9 <br /> TYPE in PS): <br /> LISinglee Family Dwelling U Garage/Accessory Structure EI Stairs LI Commercial Building R. <br /> — <br /> )Raf/Addition U Bunkhouse U Filling/Grading ❑Commercial Addition <br /> /z Deck ❑n5�9.699,2�(,-ly„),Gazebo <br /> . ❑ Camp\ing Uni[ Ll Commercial ACC. Structure <br /> STRUCTURE/ADDITION USE: `-' y, el Psi,-" �Of�II/ fJE(:I�G - <br /> z <br /> �J (Horne/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> BUILDING CONTRACTOR: Ai2F L �Cf-�sn MfiNnJ0 , 'I� J <br /> - 5 <br /> PLOT PLAN ---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. r <br /> ***REOUIRED PLOT PLAN INFORMATION*** <br /> Cl 81/2"X 11"SHEET OF PAPER DISTANCE(IN FEET)TO: <br /> ❑ DRAWN TO SCALE OR DISTANCES LABELED ❑ WELL <br /> U PROPOSED BUILDING/STRUCTURE LOCATION ❑ SEPTIC TANK&DRAINFIELD IAT <br /> 4Dimensions&Heights Cl ROAD RIGHT-OF-WAY IF SURVEYED <br /> ❑ EXISTING BUILDINGS/STRUCTURES(Includes deck, porch, etc.) -)CENTERLINE IF NOT SURVEYED <br /> -)Dimensions& Heights ❑ ALL PROPERTY LINES o <br /> U NORTH ARROW Cl ORDINARY HIGH WATEP.AWK 3. _ <br /> ❑ p�7� <br /> 1�11n <br /> NOTE: Building/structure location most be staked for onsite verification when needed. ISw� <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: SEP 29 2014 <br /> • Removal or cutting of trees antl vegetation is restricted along shoreline <br /> • NO structures(including retaining walls,etc.)are allowed unless specifically perm <br /> • No filling,grading,or shore land alterations are allowed unless specifically permitted URNETT COUNT'! <br /> • Driveway must meet width requirements within 60 days of permit S ZONINGCO - `y <br /> • Accessory structure/garage permits allow for private residential storage onlyz tL <br /> "Not to be used for human habitation Or rental storage' <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge and (I` <br /> belief it Is Rue,correct and complete. 1 achrwwledg.that I am responsible for Me detail and aaumq of all inbmu[ion wnGined in /yl <br /> this d uldoaby he Counts any accompanying schedule)and I rwheth declare that t recognize that this inbrmation pmvitle0 will be <br /> relied upon by the Countyea Burnett Wisconsin in determining whether to issue a permit 1 further accept all liability that may re a <br /> result of County or ersotrelyioe on Mh information persons <br /> providing ha ie this a to <br /> Iagree tiped pct countsatofficialsnreasonable i <br /> with foradministraffingthe purpose <br /> wunty ordinances or other authorized persons to have asxers[o the abovadescribed premises at any reasonable <br /> three for Me purpose of inzpe tion. <br /> NS <br /> ---ADDITIONAL CONORIONS--- F On ' - = I I6 <br /> —5e� Lon/7fTio� DG GAlE60 �E�m)r WulC!( AGtE�-TfIE'F/iGT n a ? _ <br /> PIA45 ro IuEGAuy l�o/ <br /> —/Vo /n5Lf2-c-i iN wAST� T rn,/ SLIF}U- arcwLL - N T <br /> aN seP17L I�"nC )qu\)Ess' = a <br /> OWNER'SSIGNATURJ;z�61�, � <br /> ZONING <br /> J-. (date) r. - <br /> `*TOWN/UDC PERMITS MAYBE REQUIRED "'THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE rt C F <br /> You are responsible far complying with state and federal laws concerning Construction near or on wetlands, lakes, and streams. -_ <br /> Wetlands that are rot associated win open water can be difficult to identify. Failure to comply may result in removal or m0difirabon <br /> ofcnnstmQion that violates the law or other penalties Or cosh. For more information visit the Department of Natural Resources <br /> wetlands identification web page Or contact a Department of Natural Resources service center. <br />