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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator r <br /> 3 <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER � yELEP�NE�ys-() 57 G a <br /> ROS! l'N, (�a,-�.✓ 7/a 2 c <br /> PROPERTY ADDRESS 2mg / jT"lilh2 (g <br /> h <br /> LEGAL DESCRIPTION �. <br /> (DJC D�' �ckJdy 3y 3RN /4GJ St >� 51,J 6� <br /> _ o <br /> S'ht// 1,,k[ 6d-T7_ (o <br /> TYPE OF PERMlT(5): <br /> ❑ Single Family Dwelling ❑ Garage/Accessory Structure 0 Stairs ❑Commercial Building <br /> A Addition Cl Bunkhouse ❑ Filling/Grading ❑ Commercial Addition � <br /> ❑Deck ❑59.692(ly)Gazebo—'-' '❑"Camping Unit --❑ Commercial ACE.-Structure - A <br /> STRUCTURE/ADDITION USE(-e-xe�/1LIG'SL 62, v <br /> o ;✓onm.r+ aB,. _ crow; Decka <br /> BUILDING CONTRACTOR: fiy <br /> , <br /> - _ <br /> [d^{" <br /> ) <br /> PLOT PLAN ---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. 't Z <br /> ***REQUIRED PLOT PLAN INFORMATION*** " O <br /> ❑ 8'/z"X 11"SHEET OF PAPERf <br /> DISTANCE(IN FEET)TO <br /> ❑ DRAWN TO SCALE OR DISTANCES LABELED ❑ WELL <br /> ❑ PROPOSED BUILDING/STRUCTURE LOCATION ❑ SEPTIC TANK&DRAINFIELD <br /> Dimensions&Heights D ROAD RIGHT-OF-WAV IF SURVEYED n W <br /> 0 EXISTING BUILDINGS/STRUCTURES(Includes deck, porch,etc.) CENTERLINE IF NOT SURVEYED '- l <br /> Dimensions&Heights ❑ ALL PROPERTY LINES __ <br /> y�0 NORTH ARROW � - EJ ORDINARY HIGH WATER MARK _ <br /> ❑ ALL WETLAND AREAS <br /> a // \ <br /> NOTE: Building/structure location must be staked for onsite verification when needed. D W z <br /> �1, <br /> THIS PERMIT IS SUBIECT TOALL CONDITIONS LISTED BELOW: <br /> • Removal or cutting of trees and vegetation is restricted along shoreline <br /> • No structures(including retaining walls,etc.)are allowed unless specifwlly perm SEP `^r <br /> • No filling,grading,or shore land alterations are allowed unless specifically permi 1 2 2014 <br /> • Driveway must meet width requirements within 60 days of permit r CIO <br /> • Accessory structure/garage permits allow for private residential storage only <br /> _..Nat to be used for Human habitation or rental storage**_ @URNETT COON o' <br /> cl — <br /> z` <br /> 1 declare that this application(inuding any accompanying schedule)has been examined by me and my knowledge and <br /> bell&It is true,correct and complete. I acknowledge that 1 am responsible for the detail and amumov of all information contained in <br /> this application(including any accompanying schedule)and I further declare that I recognize that this information provided will be I" <br /> relied upon by the County of Burrett Wisconsin in determining whether to issue a permit. 1 further accept all liability that may be a <br /> result of the County of Burnett relying on this information I am providing in this application. 1 agree to permit county officials charged 4 <br /> with administrating county ordinances or other authorized persons to have access to the above-described premises at any reasonable <br /> time for the purpose of inspeetion. <br /> � m >nnnn > o <br /> —ADDITIONAL CONDITIONS— - ' a ' <br /> mti <br /> � S <br /> OWNER'SSIGNATURE 1 1000 1)1. �J:>fM 'JO f� LO ` <br /> = 3 ^ ` S [4 <br /> ZONING OFFICIAL `i'`x' 9 /( Zoe s - <br /> o'' F'-- s <br /> Fn I <br /> ( ate) _ Y <br /> --TOWN/UDC PERMITS MAYBE REQUIRED *'TRIS PERMIT SHALL EXPIRE ONE YEAR FROM DgTE OF ISSUANCE R <br /> You are responsible for complying with state and federal laws concerning construction near or on wetlands, lakes, and streams. - In_ <br /> Wetlands that are not associated with open water can be difficult to identify. Failure to comply may result in removal or modification <br /> OfCOOS[ruQi0t1 that vi0atE5 the dw Or OIt12r penalties or costs. For more information visit [h2 DQpdrtm20t Of NdNra Resources _ -_ <br /> wetlands identifcation web page or contact a Department of Natural Resources service center. r ' ' <br />