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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator A 3 G <br /> APPLICATION FOR LAND USE PERMITS <br /> I' _ n <br /> OWNER J / I I_I�. _ ,ar�{� TELEPHONE 76 o <br /> PROPERTY ADDRESS 3 !7(bp/o 5U,,J rt `( )e�v 0, Ll <br /> ZZSS (J•S <br /> LEGAL DESCRIPTION �✓ /✓ L r S -7� T ,Ju /J � ! � Y <br /> / J Jn / //� Jl j� / <br /> MAIUNGADDRESS CJ/JZ OYf '�/Y ��UL•r. ��(� ........���!. <br /> TYPE OF PERMIT(S): _/ ✓ ' <br /> 0 Single Family Dwelling 0 Garage/Accessory Structure 0 Stairs Cl Commercial Building ("r\ <br /> Addition 0 Bunkhouse 0 Filling/Grading 0 Commercial Addition <br /> 0 Deck 0 59.692(ly)Gazebo Cl Camping Unit 0 Commercial Add. Structure 3 <br /> r 11 c <br /> STRUCTURE/ADDDTON USE: G��J •-' 'D'u fF �,Co�COI�V fyr/.f1') - i <br /> (Home/Cabin; Commerci Business; Bedroom; Deck; <br /> / etc.) <br /> BUILDING CONTRACTOR: J_ <br /> F< —✓ GU pii f 1, <br /> CJ r <br /> ir <br /> PLOT PLAN ---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> {x*REOUIRED PLOT PLAN INFORMATION*** <br /> 3 <br /> © 81/I"X 11"SHEET OF PAPER DISTANCE(IN FEET)TO' v <br /> N DRAWN TO SCALE OR DISTANCES LABELED ''A WELL <br /> 5 PROPOSED BUILDING/STRUCTURE LOCATION q SEPTIC TANK&GRAINFIELD v <br /> -)Dimensions&Heights ,0" ROAD RIGHT-OF-WAY IF SURVEYED <br /> Q EXISTING BUILDINGS/STRUCTURES (Includes deck, porch, etc.) 4CENTERLINE IF NOT SURVEYED - <br /> 4Dimensions&Heights 'S ALL PROPERTY LINES — �I <br /> Ila NORTH ARROW B ORDINARY HIGH WATER MARK = <br /> ,O ALL WETLAND AREAS <br /> NOTE: Building/structure location must be staked for cute verification when needed, p r� i [� <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: L}1' _���� <br /> • Removal or cuCdng of Vees and vegetation is restricted along shoreline VL V IISS <br /> • No structures(including retaining walls,etc.)are allowed unless specifmlly permi <br /> • No filling,grading,or shore land alterations are allowed unless specifrally pernixt SEP 3 0 2014 <br /> • Driveway must meet width requirements within 60 days of permit <br /> • Accessory structure/garage permits allow for private residental storage only <br /> '-Not to be used for human habitation or rental storage-- BURNETT COUNTY = <br /> A <br /> I Declare that this application(including any accompanying anedule)has been examined Dy me and[a y knowledge andlreinY� l <br /> -- -this application tr_,<[::CC agC ca p ctc. . ying sclhdgeedu :hat I I rther side for Me detail and aaat th of ail ima ion pro ided w I in I V <br /> Mis nyhe County any accompanying n in Bele)also I further declare that I recognize that this Information provided will be <br /> relied upon by the County Burnett sumen Wn thi sin in determining wM1eNer to issue a permit I furNer accept all liability Mat may r e a <br /> zultof Me County of countyondina relying on this information person am to <br /> eMcess to hion. (agree toPermit premisounty es <br /> nre chacombed S <br /> ged <br /> with for <br /> purpose <br /> county ordinances or other authorized persons to M1ave access m Me above-tleuribed premises at any reasonable <br /> time for the purpose al inspection. _ <br /> '> > ncao <br /> - <br /> ---ADDITIONAL CONDITIONS- <br /> �sHdPE4zNE RE5-ro.�lio�RESE.2 Ulfn� /�:.QfE.taEiV7- �EEl/5 a ��� d m � �� <br /> �1 7o eE �oAOED 5Y rr�za�z�/y. m �a = =ti f <br /> MdK6 -rH#A1 5090 of THE orAC2 _rit AAc <br /> AGTE eED �� / PL/1cE0• © RECOy D GoADs Y}NO FLONS - — <br /> 5H4 <br /> 1- <br /> L NV; <br /> OY 6XcE6D 35 N6Y�nHT GZJr1YT, J M By II Rzo/y G c -_ c z <br /> OWNER'S SIGNATURE Q/ - 7-9V$ > <br /> Y (dace) y x <br /> ZONING OFFICIAL C O ZcJ Z(J 7 '_' <br /> ) = ac a <br /> ­TOWN/UDC PERMITS MAYBE REQUIRED *'THIS PERMIT SHALL E%PIRE ONE YEAR FROM DATE OF ISSUANCE - <br /> You are responsible for complying with state and federal laws concerning erring conlure to n near or y r wetlands, lakes, and streams. _of <br /> con ds That are not associated with open water can be r costs to identify. Failure to comply may result in removal or modification <br /> of construction that violates page <br /> law or other penalties or mats. For more information vie[ the Department of Natural Resourtes U - s _ r <br /> wetlands iden[iFlration web page or contact a Department of Natural Resources service center. - � <br />