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z r <br /> Burnett'County 7410 County Road K, No, 102, Siren,Vol 54872 Office of Zoning Administrator <br /> APPLI CAT[ ON FOR LAND USE PERMI TS - <br /> OWNER 6AY66 13"EF- to 51 ¢80'738(0 rt <br /> FROFIIiTY ADDRESS 29285 (o�y p-0a� JACKS IOtyNs,+,r, W1 54830 ' <br /> 07- o/2- 2 -40 -15 -o(- 505- do(- 6 20001 e <br /> MAILING ADDRESS 335 &140A def mel ZIM0 1AW5T W5.5 <br /> TYPE OF PERMIT(S): <br /> ❑ Single Family Dwelling ❑ CsragerAecessory Structure ❑ Stairs ❑ Commercial Building <br /> ❑ Addition ❑ Bunkhouse D Filling/Grading ❑ Commercial Addition .$ <br /> ❑ Deck }( 59.692(ly) Combo ❑ Camping Unit ❑ Commeraal Aa. Structure <br /> SRil1CIlAiFJADDITION US' �E-PiK g Z <br /> II rr � (HomelCebin; Commercial 91siness; Bedroom; Oeck: etc) Cl <br /> _ BUIIDINc17]IJIRq[,TOR Ft9MF.nWNStL o �� <br /> PLOT PLAN --- 1 NCOM PLETE OR I LLEGI BLE PLOT PLANS WILL BE RETURNED. � ^_ <br /> "'REQUI RED PLOT RAN I NFOFM4ATI ON"' <br /> X 11' SHEET OF PAPER DISTANCE(IN FEET) TO: d t <br /> �( DRAWN TO SCALE OR DISTANCES LABELED �f WELL <br /> �C PROPOSED BUI LDI NGI STRUCTURE LOCATI ON Y SEPTI C TANK&DRAI NF1 ELD <br /> VC Dimensions& Heights ❑ ROAD RC fT-OF-WAY I F SURVEYED <br /> K D(I SII NO BUI LDI NGS'STRUCTURES H ncude;deck, porch, etc) ❑CENTERU NE I F NOT SURVEYED <br /> Dimensions& Heights K ALL PROPERTY LINES q ) <br /> X NORTH ARROW X ORDI NARY HI CJI WATER MARK rt b <br /> w E- <br /> NOTE Bliltlinglstrvdure location b <br /> tion mug staked for onsite verification when etled.El ALL WETLAND AREAS as 1 <br /> 3 <br /> THISPERMITISSUBJECT TOALL CONDI TIONS LISTEDBFIOW: y LI <br /> No strut or coding of trees gni vegetation is are allowed <br /> along shoreline 2 <br /> ✓i No structures(inducting retaining walls,etc)are allowed unless spekically Permitted <br /> No filling,grating, t More land alterations are showed!unless speafiplty permitted <br /> ✓ Driveway must meet crag requirements for private <br /> days of permit <br /> {/ Pcassory a tight rfo puma permits allow far private residential storage only a <br /> Net to be used for human habitation or rental Swage" <br /> 1 et da a that this application(including any accompanying schedule) bas been examined by m and to the best of my knowledge and <br /> beliM it is true,correct and complete. I acknowledge that I am responsible for the derail and accuracy of all information contained in Ill/ <br /> INs appllcbad (intluclog any accompanying schedule) and I further declare that I recognize that this information provided will pe <br /> relied upon.dy tha county of B-mict Wisconsin In determining whether to issue a permit. I further accept all hardily that may be a <br /> sult of the county of Burnett relying on this information l am providing In this application. l agree to permit county offrials charged S <br /> with administrating county ordinances or other authorized perwns to have access to the above-described premises at any reasonable <br /> rime for the parpase of inspection. <br /> --nDDlgn oNAL lbyN�orn�ojl�vs-- t be ; <br /> or 11fS - <br /> �yS r QE� PIEYci�j 7S, y �$a <br /> —0411-Y Z-o'-F2 � lcl ECME BaS- <br /> � t <br /> c acJ�y as ak, plwt. JUL 1 52014 0 > <br /> a <br /> OWNER'S SI GNATURE <br /> NTY 7 NLN� _ 9_a9 . con orJf T .�,l <br /> ZONI NG OFR G AIS 1.J _ N . F3' o�N <br /> (date) _ C <br /> ^TOWNIUDCPERMITSMAYBERMUIRED "THISPERMITSHALLIXPIREONEYEAR FROM DATEOF I SSUANCE <br /> You are responsible for complying with state and federal laws concerning construction rear w an wetlands, lakes, and streams. ce <br /> Wktlands that are not assodated with open water am be difficult to identify_ Failure to comply may result in removal or modification <br /> of cendrudion that violates the law or other penalties m mels. For more information visit the Department of Natural Rasourvs ��.+o ch o g <br /> wetlords identification web page or contact a Depadmeol of Natural Resources service center. <br />