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r <br /> Burnett County 7410 County Road K,No. 102, Siren,WI 54873 Office of Zoning Administrator a <br /> = Ce <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER —T— TELEPHONE - p <br /> PROPERTY ADDRESS <br /> /y7ckeriz.e oc;cQS�boner Gy1 0 <br /> Ln rs y Y g grocK A Lake "Id Krni la 9e�c in 5'a.4,';, •ion I = <br /> LEGAL DEBCRIPTIIXJ mita{= G.�IY (�,>Y,I sem. i3v Ynrt pf SE✓y SE yfy, Se-e /y T'%oNR/Y!✓ <br /> Sec nlRtc Lltd F F.//des cr%,ri:kra an t <br /> a <br /> MAILING ADDRESS yVy ,,tC- OPnpd/%� /'Vl/1J S�z//7 <br /> TYPE OF PERMIT(S): Jra I _ <br /> ❑ Single Family Dwelling rb Garage/Accessory Structure ❑ Stairs ❑Commercial Building -_ <br /> ❑ Addition ❑ Bunkhouse ❑ Filling/Grading ❑Commercial Addition <br /> ❑ Deck ❑ 59.692(ly)Gazebo Cl Camping Unit ❑Commercial Acc. Structure <br /> STRUCTURE/ADDITION USE: G am �STdIC pQaG `,� <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) _1 <br /> z C <br /> BUILDING CONTRACTOR:�f•l '. �onsf-ra:c'f�on O <br /> PLOT PLAN---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> ***REQUIRED PLOT PLAN INFORMATION*** <br /> ❑ 81 1 C'SHEET OF PAPER DISTANCE(IN FEET)TO; f C' <br /> ❑ DRAWN TO SCALE OR DISTANCES LABELED ❑ WELL L� <br /> ❑ PROPOSED BUILDING/STRUCTURE LOCATION CI SEPTIC TANK&DRAINFIELD <br /> -)Dimensions&Heights ❑ ROAD RIGHT-OF-WAY IF SURVEYED _ <br /> ❑ EXISTING BUILDINGS/STRUCTURES(Includes deck, porch,eta.) 4CENTERLINE IF NOT SURVEYED = <br /> -)Dimensions&Heights ❑ ALL PROPERTY LINES L <br /> ❑ NORTH ARROW ❑ ORDINARY HIGH WATER MARK -_ <br /> J ALL WETLAND AREAS IH-- <br /> NOTE: Building/structure location must be staked for onsite verification when nestled. o) F <br /> THIS PERMIT IS SUEIELT TO ALL CONDITIONS LISTED BELOW: 1 _ <br /> • Removal or cutting of tress and vegetation is restricted along shoreline - <br /> • No structures(Including retaining walls,etc.)are allowed unless specifically permitted <br /> No filing,grading,or shore land alterations are allowed unless specifically Permitted ` <br /> Driveway must meet width repui ements within 60 days of cermit Y/ <br /> Accessory structure/garage permits allow for private residential storage only <br /> "Not to be used for human habitation or rental storage" d <br /> I earlam that Mia applimbon(including any acmmpa"inq mM1 .tl )has been esamimd by me aM m Ule best&my kr lMW aM <br /> V <br /> belief It Is=correct and complete. I acknowledge that I am responsible for me demll and accuracy of all Information cenbined In <br /> mil eppNtnby he(including ty any acwmpanylnq schedule)and 1 hither r W issue a I Permit <br /> izf that this abomination prmltM will be <br /> relied upon by Me County a Burnett Wisconsin in determining i am wM1Hber to Issue a permit 1 further adept all Iu blyry Na[may be a <br /> resouwith dmiof ni County afeumehament nceng o r Mbinfwmanonl asterproviding have <br /> eMlsss,to the <br /> [agree rosat pitmunr as any charged Q <br /> with administrating eounry o,dlnazes w other auNorlxM persona to have access to Dw above-0eswlbMl1/'I p�r-r1e(�ImL�ri�sesM[any reasonable G' <br /> brae for the Purpose Of IONSUOn. VLJ _ ` u 5 z <br /> L�y jrt <br /> --ADDITIONAL CONDITIONS— t w K 3 3 3 ?_ 9. <br /> AUG 4 2014 a <br /> _ 4 <br /> BURNETTCOUNTY ssbe <br /> ZONING 9 <br /> t: <br /> ZONING <br /> OWNER'S SIGNATURE A'1-�.� y /v o / n _ <br /> (dam) ` _ ` 3 u _ c. <br /> ZONING OFFICIAL <br /> N <br /> —TOWN/UDC PERMITS MAYBE REQUIRED "THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE _ <br /> Y06 are responsible No complying with state and federal laws concerning ministration near or on wetlands, lakes, add streams. <br /> Wetlands that are not associated with open water can be difficult to identify.Failure to comply may result in removal or modification <br /> of cons[NCtion that Violates MC law or other Penalties or costs. FOr more information viii[ the Department of NaturalRCsoufces <br /> wetlands identification web page or contact a Oeorunent of Natural Resources service center. <br /> 1 \ <br />