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Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administrator g 3 C <br /> APPLICATION FOR LAND USE PERMITS 7. iF9 <br /> L <br /> OWNER TELEPHONE - - <br /> Y AA0771Y e,7-AC6V FLlN6 M00AL41'7 6Sl -yS9-025'0 <br /> PROPERTY ADDRESS'2S /S3 IV . 4 A✓A RT) - wE6S1 /2 C. T S tf 9?3 � J <br /> LEGAL DESCRIPTION LOT 3 CSM V 9 P 1St. (IN NE NW) <br /> MAILING ADDRESS S(,a.3 J�NN�K LANC _ (z7`7'Mr£ t)ysOl� MN SSolb <br /> TYPE OF PERMIT(S): <br /> ❑ Single Family Dwelling Garage/Accessory Structure ❑ Stairs ❑Commercial Building <br /> ❑ Addition U Bunkhouse ❑ Filling/Grading ❑Commercial Addition .� <br /> U Deck ❑ 59.692(ly)Gazebo ❑ Camping Unit ❑Commercial Acc. Structure 3 <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin; Commercial Business Bedroom; Deck; etc.) <br /> a UJ <br /> BUILDING CONTRACTOR: i ESMLp At/IL-DINS — <br /> v_ m <br /> r <br /> PLOT PLAN ---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. '° Z <br /> *'-REQUIRED PLOT PLAN INFORMATION*** m <br /> ❑ 8'h"X 11"SHEET OF PAPER DISTANCE(IN FEET)TO' G <br /> ❑ DRAWN TO SCALE OR DISTANCES LABELED U WELL L <br /> ❑ PROPOSED BUILDING/STRUCTURE LOCATION ❑ SEPTIC TANK&DRAINFIELD — - <br /> 4Dimensions&Heights ❑ ROAD RIGHT-OF-WAY IF SURVEYED N ID() <br /> U EXISTING <br /> 40imen BUILDINGS/STRUCTURES(Includes clock, parch,etc.) ALL <br /> PROP RUNE IF NOT SURVEYED - l <br /> �Dlmensions&Heights U ALL PROPERTY LINES o y"p1 <br /> ❑ NORTH ARROW U ORDINARY HIGH WATER MARK <br /> U ALL WETLAND AREAS <br /> NOTE: Building/structure location must to staked for omite verification when needed. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> • Removal or cutting of trees and vegetation is restricted ato along shoreline <br /> No structures(including retaining walls,etc.)care allowed unless eofiihaally permitted <br /> No filling,way grading,or shore land alterations are allowed unless specifically permitted <br /> • Driveway must meet width requirements within days of permit <br /> Accessory structure/garage permits allow for private residential storage only <br /> '`Not to be used for human habitation or rental storage" <br /> I declare Mat this application(Including any accompanying schedule)has been euminal by me and to the best of my knowledge and 1� <br /> belief It is true,comm[and complete. I acknowledge Mat I am responsible for the derail and accuracy of all information contained In INS <br /> this application(including any accompanying actedule)and I further declare Mat I recognize that Mis information provided will be <br /> relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I further accept all liability that may be a <br /> result of Me County of Burnett relying on Mia Information I am providing in this apPliotion. I agree to permit county officials charged G <br /> with administrating county eminences or other authorized persons to have access to the above-described premises at any reasonable <br /> time for the purpose of inspection. <br /> --ADDITIONAL CONDITIONS--- ECOVED D x <br /> AUG 11 2014 - t6v = <br /> Ta = <br /> BURNETTCOUNTY 'fix <br /> ZON <br /> OWNER'S SIGNATURE "0 <br /> 1 (clot ) 5 `. <br /> ZONING OFFICIAL_ _ -tom <br /> (date) - <br /> '•TOWN/UDC PERMITS MAYBE REQUIRED *`THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE -You are responsible for complying with state and federal laws Concerning construction near or on wetlands, lakes, and streams. — <br /> Wetlands Nat are not associated with open water can be difficult to identify. Failure to comply may result in removal or modification ' 3 ' <br /> of construction that violates the law or other penalties or costs. For more information visit the Department of Natural Resourcesas <br /> wetlands Identification web page or contact a Department of Natural Resources service center. " c <br />