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Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> Ca <br /> APPLICATION FOR LAND USE PERMITS - <br /> i ON COMPUTERS A fid A <br /> OWNER rLd7l0 Ql- 1f//✓I�P../f 2L-Jj=jZ TELEPHONE (_ <br /> "LET'N,-aro G Toy <br /> PROPERTY ADDRESS (a-7 11,9�� EN L�/,'� /, �Jlpne` �k�4 p� <br /> "iw <br /> A. <br /> of -1 <br /> LEGAL DESCRIPTION i <br /> /2 I✓U1 tut Lena sCir yl 4! �cP' Lr, i Tl <br /> n <br /> LV <br /> MAILING ADDRESS <br /> TYPE OF PERMIT(S): D 7 JT T o <br /> ❑ Single Family Dwelling Garage/Accessory Structure U Stairs 0 Commercial Building = N <br /> Cl Addition ❑ Bunkhouse Cl Filling/Grading Cl Commercial Addition .? <br /> U Deck /SLI 59.692(ly)Gazebo D Camping Unit Cl Commercial Acc. Structure <br /> STRUCTURE/ADDITION USE: Z <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) — <br /> cC o JJ 7 <br /> BUILDING CONTRACTOR:J_�)�/Mli�l 8L1 r� /U ,nC/f �,56r(/Tsyn Gr^-+p �J(� s <br /> 3•LTtn JFt E rlt0 CC Tr _ s <br /> PLOT PLAN --INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. — a <br /> _ ry <br /> ***REQUIRED PLOT PLAN INFORMATION*** <br /> U 81h"X 11"SHEET OF PAPER DISTANCE(IN FEET)TO: o <br /> D DRAWN TO SCALE OR DISTANCES LABELED ❑ WELL o <br /> U PROPOSED BUILDING/STRUCTURE LOCATION D SEPTIC TANK&DRAINFIELD SJ <br /> -)Dimensions&Heights D ROAD RIGHT-OF-WAY IF SURVEYED .� <br /> D EXISTING BUILDINGS/STRUCTURES(Includes deck, porch, etc.) -)CENTERLINE IF NOT SURVEYED - <br /> -)Dimensions&Heights ❑ ALL PROPERTY LINES - Q <br /> D NORTH ARROW U ORDINARY HIGH WATER MARK <br /> Cl ALL WETLAND AREAS I _ <br /> NOTE: Building/structure location must be staked for Onsite verification when needed. jTHIS PERMIT 15 SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> • Removdl or cutting of trees and vegetation is restricted along shoreline D ,� 7,• No structures(including retaining walls,etc.)are allowed unless specifically pens V <br /> • No filling,grading,or shore land alterations are allowed unless specifically permi SEP 2 4 2014 <br /> • Driveway must meet width requirements within 60 days of permit - <br /> • Accessory structure/garage permits allow for private residential storage only BURNT CO UN ` RJ 9.3ge" <br /> "Nat to be used for human habitation or rental storaTY <br /> u x <br /> I declarei onhat Mssrrecadapplicationcomplete. <br /> I any accompaacknowledge <br /> Mat schedule)respnsi leen examinee by a and to the best information Fn contai e d in <br /> belie/itis true,correct and complete. I acknowleltge Nat I am responsible Por Me I-rec aniz accuracy of all mationpna contained in <br /> this p ontby (including of Bur ett W sc ng in dee)milt I Iwheth r to issue <br /> Matz recognize that this information liability <br /> y Oat lt will be <br /> result upon by Me County a Burnell Wisconsin in determining I am wM1eMer in issue a permit. I tartlet accept all liability Ma[may the a <br /> result olMetounry ofuntyorinantt cgo rMisinformation)ampmvio pain thisapplication. <br /> toaeaboagreetopermit county offldalssonamrl + <br /> with faradministratinge ,ocounty ordinances or other authorized persons to have access ro the above-ltescdlM premises at any reasonable <br /> time Tor Ne purpose of lnzpeRion. <br /> -ADDITIONAL CONDITIONS--- F w 5 z 3 9 cr <br /> c <br /> ONEEP To oh7wz1v Mjwr P6kMZ7_ Bf 11115IZOI <br /> o8A <br /> OWNER'S SIGNATURE �. Z(ll'-Ai n ft? <br /> ZONING OFFICIAL / 7-+ ZOO <br /> (ltaro) F <br /> *'TOWN/UDC PERMITS MAYBE REQUIRED **THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE _You are responside for complying with state and federal laws concerning construction near or on wetlands, lakes, and streams. 8 <br /> Wetlands that are not associated with open water can be difficult to idendfy. Failure to comply may result in removal or modification c— <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. - e ' - <br />