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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS - <br /> OWNER TELEPHONE s f <br /> O <br /> PROPERTY ADDRESS 3�6L n rX P 1�,�L I r <br /> LEGAL DESCRIPTION GOV O' I / OF I <br /> W CTi� <br /> MAILING ADDRESS I� (1 w,ja y M-/ <br /> TYPE OF PERamily D U( Gana (� I I IlV 7041 <br /> ❑ Single Family Dwelling Garage/Accessory Structure Ell Stairs Ll Commercial Building ILS <br /> Cl Addition CJBunkhouse ElFilling/Grading ElCommercial Addition a"� <br /> ❑ Deck ❑ 59.692(ly)Gazebo ❑ Camping Unit ❑ Commercial Ace. Structure <br /> STRUCTURE/ADDITION USE: U-wr—_y Z <br /> / eJCabin;Commercial Business; Bel ; etc.) <br /> A <br /> BUILDING C NTRACTOR--� �.liL O <br /> T <br /> n <br /> /190 lV-11/0rA 2j, <br /> PLOT PLAN ---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. z <br /> ***REQUIRED PLOT PLAN INFORMATION*** <br /> 81h"X 11"SHEET OF PAPER DISTANCE(IN FEET)TO: o <br /> ❑ DRAWN TO SCALE OR DISTANCES LABELED ❑ WELL <br /> ❑ PROPOSED BUILDING/STRUCTURE LOCATION ❑ SEPTIC TANK&DRAINFIELD tit <br /> 4Dimensions& Heights ❑ ROAD RIGFI7-0F-WAY IF SURVEYED <br /> ❑ EXISTING BUILDINGS/STRUCTURES(Includes deck, porch, etc.) -)CENTERLINE IF NOT SURVEYED <br /> -)Dimensions&Heights - ❑ ALL PROPERTY LINES _o <br /> ❑ NORTH ARROW ❑ ORDINARY HIGH WATER MARK s <br /> 1 ❑ ALL WETLAND AREAS <br /> NOTE: Building/structure locaton must be staked for onsite verification when needM. w ? l <br /> ' THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> Removal or cutting of trees and vegetation is restricted along shoreline <br /> structureslf('OV�,)r Ire <br /> No structures(including retaining walls,etc.)are allowed unless specifically permitted <br /> • No filling,grading,or shore land alterations are allowed unless specifcally permitted W <br /> • Driveway must meet width requirements within 60 days of permit — V <br /> Accessory structure/garage permits allow for private residential storage only -- <br /> **Not to be used for human habitation or rental storage" <br /> i A <br /> t declare that this application tandin fete. a n Tam reae has been Me detail b m and f m knowledge(including any accompanying ) Y e ro Me Oert o y o edge anti <br /> Belief it is Vee,correct and complete. t acknowledge Matt am rmer ziMe for Me derail and accuracy this <br /> s i all informationanonro contained in <br /> f this application by <br /> e county any accompanying n in dee)and t twheth declare Matt recognize Mat Mis intormatlon provided y b be s <br /> relied upon c Me County of Burnett Wisconsin in determining whether in issue a Watio t farmer avert all liability officials Match r,c a <br /> withresuadministrating <br /> Me County comm orainance on Misinformation tamainsto have MisastlirMe attagree ri Permit isesayreasoargM ± <br /> with for the on roue wunsY ordinances m other authorized persons to have access ro Me aM1ove-tleuribetl premises at any reasonable <br /> time for Me on rouse o1 inspection. <br /> n 'n > nnnn > — <br /> n333ndi <br /> ---ADDITIONAL CONDITIONS--- / p❑� <br /> Q�rot, Pipe- Inds gsSuwlC.Q )/cJ d�7yie illEcovNP,4'' D EC E1 Da <br /> o Ne AroPos� qyr ye zf lGr's r3 a4ffiYc�) am <br /> I(12t� colN�fiu�{ o✓✓ is tw� cillowcd LC'I {Vuf- JUL 28 2014 w T <br /> ANott er SI� U # 0- 6e*a,�ne�om <br /> 2 / 7,p t TG 0 6 BURNzEnTiwtC,1(O,UNTY = _ ^ ' <br /> z/ Bui�rL)Aq oN�Pe/I�v /'S ` . .e .564oq 4 - <br /> �- WNER'S SIG ATURE ��{/'�yt <br /> c c r <br /> (at ) <br /> 20NING OFFICIAL -713 <br /> ZOl P ', _ - <br /> u o g <br /> c : `r <br /> ­TOWN/UDC PERMITS MAY BE REQUIRED "*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 wind open water can be difficult to identify. Failure to comply may result in removal or modification 8 ' <br /> of construction that violates the law or other penalties or costs. For more information visit the Department of Natural Resources '^ _ <br /> wetlands identification web page or contact a Department of Natural Resources service center. 8 o o c <br />