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Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administrator - - G <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER TELEPHONE - c <br /> Gceeyd- Sea, bonnet% 9S1- 9y3 - 736/ ct <br /> PROPERTY ADDRESS An <br /> .-1 91d <br /> LEGAL DESCRIPTION <br /> Lo G.r SLo.--.. La�'-k- � U �SL•ore�� � ' �-' <br /> MAILING ADDRESS 1003LI <br /> /�6es� <c�GI <br /> I� <br /> G� Lal ��, i/e, i�'/NSsavy N _ <br /> TYPE OF PERMIT(S): Y <br /> J Single Family Dwelling pLGarage/Accessory Structure J Stairs J Commercial Building71 <br /> J Addition U Bunkhouse J Filling/Grading Cl Commercial Addition <br /> J Deck Cl 59.692(ly)Gazebo J Camping Unit J Commercial Ace.Structure <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) <br /> F <br /> BUILDING COfITPAROR: "fA�z ).7 0. nC <br /> PLOT PLAN---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. _ y <br /> ***REOUIRED PLOT PLAN INFORMATION*** ap <br /> J 8'/x"X 11'SHEET OF PAPER DISTANCE(IN FEE TI TO: _— <br /> J DRAWN TO SCALE OR DISTANCES LABELED J WELL C's <br /> J PROPOSED BUILDING/STRUCTURE LOCATION J SEPTIC TANK&DRAINFIELD - <br /> -)Dimensions&Heights J ROAD RIGHT-OF-WAY IF SURVEYED = o <br /> J EXISTING BUILDINGS/STRUCTURES(Includes dock, porch,etc) -)CENTERLINE IF NOT SURVEYED -L <br /> 4Dimensions&Heights J ALL PROPERTY LINES — - <br /> J NORTH ARROW J ORDINARY HIGH WATER MARK = <br /> J ALL WETLAND AREAS (� <br /> NOTE: Building/structure location must be staked for onsite verification when needed. ������ <br /> THIS PERMIT IS SU83EUTO ALL CONDITIONS LISTED BELOW: D D _ 0) � <br /> • Remeval or cutting of trees and vegetation is restricted along shoreline ) <br /> No structures(including retaining walls,etc.)are allowed unless specifically n t fied 2 9 2014 r <br /> • No lling,grading,or shore land alterations are allowed unless specifically Il <br /> • Driveway must meet width requirements wahln 60 days of permit �. <br /> • Accessary structure/garage permits allow for private residential storage only <br /> ••Not to be used for human habitation or rental storage- <br /> BURNETT COUNTY �' <br /> I h rhyme or m information <br /> a and <br /> 1 declare that tM1iz application(including any accompanying schedule) as been e=aminetl n y q <br /> this application <br /> it is true,correctandcomplete I yang sch that t am responsible <br /> ne me aebN and accuracy thi bt fo imation con provided <br /> will <br /> Inallied upon <br /> d upon by he county <br /> any accompanying z in dee)and I further whether to iss eat I recognize that talc pta ll kaon y that tl will a y/ ` <br /> result upon by unt County e t mlyin Wbcansin in ation i am villinto issue a pennon I further accept all liability that may be a <br /> result of the county of Burnett relying on this Information l am ons to ha In this ss do <br /> ag r agree to permit county t ad,re charoe4 <br /> with for <br /> purpose <br /> county oction. es or other authorized persons to have access W the abovg4eurlbN premises at any reasonable <br /> time for[he purpose o(insptttion. _ <br /> --ADDITIONAL CONDMONS--- I II }I / ��1 <br /> Ca pu � be— ye'"� L <br /> 'W R P�'w lr �b /Q/MUA tyg /� ^ Uc33p <br /> a � fiz <br /> OWNER'S SIGNATURES ✓Cv✓t/'t-✓C 1. R.-� i _Lc� _ -i> 3 n o v__ r. <br /> ZONING OFFICIAL (2, /3e 7K9/ <br /> --TOWN/UDC PE MITS�UIRED —THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE _ - - <br /> You are responsible for complying with state and federal laws concerning construction near or on wetlands, lakes, and 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 construction that violates the law or other penalties or carts. For more 'n ormadon visit the Department of Natural Resources vi <br /> o.g <br /> wetlands identification web page or contact a Department of Natural Resources service center. " <br />