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Bureett County 7410 County Road R,No. 102, Siren,WI 54871 Office of Zoning Administrator = <br /> APPLICATION FOR LAND USE PERMITS - <br /> OWNER IQ <br /> PROPERtt PDDRE55 'Z(�2 I I•X`/IfIPr LK-I![' �iLt-SON 70WV�_ �� rW� R1 0 <br /> LEGALDEGCRIPTION L4_ <br /> D/ b4_ 4 CSm VUINmP_ &,,7 40� 3 <br /> 3 ( <br /> MAILING ADDRESS C <br /> /D'�S ✓Yl Zff f4 0f IN '�)`OrEJ'L'-V /N S�OIZL I/ <br /> TYPE PER : f <br /> ❑Single Family <br /> Dwelling ❑ Garage/Accessory Structure ❑ Stairs ❑ Commercial Building I'V`"1 �'- <br /> ❑ Addition ❑ Bunkhouse Cl Rlliug/Grading Cl Commercial Addition <br /> ❑ Deck ❑ S9.692(1v)Gazebo `.EtCampillg Unit ❑Commercial Add. Structure <br /> srntcTURF/ADDrr[Dry USE: �nr'I I S Za)I S Orr l S ZtvS' `� <br /> (rlpme/(adn;Commercial Blsin ;Bedroom;Dedi etc.) <br /> WILDING CONTRACTOR: A <br /> m <br /> -'-=PLOLPIAN---INCOMPLETE OR ILLEGIBLE PLOT PUNS ME BE RETURNED. <br /> ***REQUIRED PLOT PLAN INFORMATION*** « <br /> ❑ Blh"X11"SHEET OF PAPER DISTANCE(IN FEET)TO, h a `J <br /> 11DRAW DRAWN TO SCALE OR DISTANCES LABELED CI WELL IIT' l <br /> 13 PROPOSED BUILDING/STRUCTURE LOCATION ❑ SEPTICTANK&DRAINFIELD SLI <br /> Dimensions&Heights ❑ ROAD RIGHT-OF-WAV IF SURVEYED H h <br /> ❑ EXISTING BUILDINGS/STRUCTURES(Includes deck, porch,etc.) iCENTERLINE IF NOT SURVEYED WW <br /> -3oDimenvm5&Heights ❑ ALL PROPERTY LINES p <br /> ❑ NORTH ARROW ❑ ORDINARY <br /> HIGH <br /> xTWATER MARK' - <br /> NOTE: Buflang/structure location most be staked for orsite verification when reeled.❑ D L 'I _I�11\yl lr Ill s 1 <br /> MIS PERMIT IS SUBJECT TO ALL CONDIIIONS❑ME BELOW: vLS ll ll l5 D I Lice. 11 <br /> • Removal ar adGrg W trees and vegedtion rs resmcmd along sM ecifi FEB 112015 <br /> • No smxmrra i nc,Ming retaining walls,ac.)are allowed unl¢s rific lly <br /> • No filling,grading,or slwre IoM aReratiowi are 60allowed <br /> do,offers spe:ifially perch <br /> • Acceway most meet nog reluars.11 s within a days of permit <br /> • ANottrvetrucmforhu aPermitallowmrPivatefaidentialstorageDory BURNETT COUNTY <br /> *'Not m be used for human habgatbn or rental smrage** ZONING <br /> F <br /> I derlam that thea awlior on('including any accompanying schedule)has base sustained by me and to the beat of my knowledge and <br /> belts It is tine,correct and consulate. I acknowledge bat I am respcsible for the derail and accuracy of all information coubiesd in <br /> Mu application(Including any recompauNnp schedule)and I farther declare that I mundane that thin information pervided will be <br /> relied upon by the County of Burrett Wisconsin in determining whether to have a parmit I Number accept all liability that may be a <br /> result of the Courcy a Buren mlying on this Information I am providing fn this application. I some to permit ruunty officials charged <br /> 'with admin W rang county ordinanm or other amounted perces to have accm to the abrre-described grembes at any reasonable <br /> time for the perform,of inspection. <br /> r > s� oav <br /> -ADDITIONAL CONDITIONS--/ / / ',/ 1 w // /OAS =w 3 'a 3 c. <br /> �r.G4 / P "17bf"` Y1G �,/5 f79Y]N9 Tf1� Ac, Uv b TGT/ 3 a R <br /> // -/ B <br /> /ffe H perms 3o- v3C6)(z)(�)� by y S /S, m <br /> � A/rzd <,- aa/dv�s s NL,w,b ,r by 1/is�iS, s; �e c ^ 3 'iff- <br /> '�"�e- �M�-,*ra. �o ca ><+on 5 C�nox9ea� a 4+• -e.✓eh'11`' �7 uln� ef^ a m <br /> OWNER'S SIGNATURE <br /> un C 6= m <br /> ZONINGOFF[CIAL Z /S 7A/r z £_ '=. 'gw cam' <br /> (d as, S n <br /> **TOWN/UDC PERM MAYBE REQUIRED **THLS PERMIT SHALL E%PIRE ONE YEAR FROM DATE OF ISSUANCE <br /> You are responsiNe for comptyinm with state and federal laws conccrcrg construction near or on wadands, lakes, and streams. - <br /> Wedands that are not azw-aced wrth open water an be difficult to identify.Failure to comply may result in removal or modification 2 <br /> of constroca n that violates the law or ober penalties or costs. For more information visit Iter Department of Natural Reoramm - <br /> wetlands ideMfiation web page or contact a Department of Natural Resources sefda renter. w 8 c = ' <br />