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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> c A <br /> OWNER TELEPHONE -1 <br /> < <br /> PROPERTY ADDRESS I 65)' r7Y0-39oy - No.ne <br /> 8121 S i I ns'nn LaK� Ll {t �,rL syyt2 0 <br /> p0(`Gov ya��+ loT'?3r3j _ 1 <br /> LEGAL DESCRIPTION <br /> 0/N 9 x•J ��a 3 08300 N o7 b}O A '/p lb 23-i OS0oLoASed / <br /> cSYI <br /> MAILING ADDRESS Q IO � ,f ' / <br /> aldo3 �GFn, G' -.✓ y� c soa - <br /> TYPE OF PERMIT(S): I <br /> XSingle Family Dwelling ❑ Garage/Accessory Structure ❑ Stairs ❑Commercial Building <br /> ❑ Addition ❑ Bunkhouse ❑ Filling/Grading ❑Commercial Addition <br /> ❑ Deck rr ❑ 59.692(ly)Gazebo ❑ Camping Unit ❑ Commercial Act. Structure .� <br /> STRUCRIRE/ADDTTTON USE: 6a r 0 <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) Z <br /> P �d 'li x Yr�J <br /> BUILDING CONTRACTOR: Vr B �nn��r✓��. On - To�e+_ J7r r.:7< C <br /> • ^ _ N I <br /> PLOT PLAN ---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. " z <br /> ***REQUIRED PLOT PLAN INFORMATION*** _ <br /> 9 84x'X 11"SHEET OF PAPER DISTANCE(IN FEET)TO - <br /> Q DRAWN TO SCALE OR DISTANCES LABELED 'FJ WELL <br /> W PROPOSED BUILDING/STRUCTURE LOCATION -f3—SEPTIC TANK&DRAINFIELD '� c <br /> -)Dimensions&Heights ❑ ROAD RIGHT-OF-WAY IF SURVEYED <br /> 91 EXISTING BUILDINGS/STRUCTURES(Includes deck, porch,etc.) i"CENTERLINE IF NOT SURVEYED <br /> 4Dimensions&Heights ,6 ALL PROPERTY LINES <br /> !T NORTH ARROW -V� 19 ORDINARY HIGH WATER MARK =. <br /> .O ❑ ALL WETLAND AREAS <br /> NOTE: Building/structure location must be staked for onsite verification when needed. <br /> THIS PERMIT IS SUBJECT TO ALL 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 specifically permitted <br /> • No filling,grading,or shore land alterations are allowed unless specifically permitted <br /> • Driveway mug meet width requirements widiin 60 days Of pernit E OJ <br /> • Accessory structure/garage permits allow for private resAermal storage only <br /> *Nat to be used for human habilation or rental gorage•' - <br /> A <br /> I declare that this application(including PP ( l ng any accompanying schedule)has been me detail by me and to aM1e bert of my information <br /> knowledge and <br /> this application it is truth correct and complete. I acknowledge Ma[t am responsible for the derail and accunaT or all imation ro contained in yt�J1 <br /> Nis y (including any rued Wisconsin <br /> sc ng schedule)and I further declare that I recognize that this ptormatlon Provided will be <br /> relied upon by the County of Burnett on this <br /> in determining whether in issue a permit. I further accept all o ntyo that may Ica a <br /> result dmithe Gating ofunty ed ordinance on tail information l onans to hasp this tapplication.iabdwsgree to permit cines at any r reasonable '< I <br /> with fier Me purses county ordinances or other authorized permns q love access q the above-0esctibed Premises at any reasonable <br /> time for Ne purpose of inspection. <br /> nT, > > r <br /> DITIONAL wt <br /> EC <br /> n/� 3 <br /> Do t oi'sfur6 7fve --r�uNd ,,I/V 4Sev' ton lOI 6vm D LSIV EN D J a a <br /> Cell . � 6e <br /> JUL 15 201, <br /> Direc� sur�nce. rLAA o{'� gwoy -GVM 7`%e mluxa/. ! r <br /> ' BUFiNETT COUNTY G n 88 = <br /> Z7 �, <br /> OWNER'S SIGNATURE /9IN - <br /> xn Cmn <br /> ZONING OFFICIAL/ �r� 7 /(� /7 <br /> --TOWN/UDC PERMITS MAY BE REQUIRED **THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE - -You are responsible for complying with gate and federal laws concerning construction near Or on wetlands, lakes, and streams. <br /> Wetlands mat are not associated with open water can be difficult to identify. Failure to comply may result in removal or motlifcation 8 <br /> of construction that violates the law or other penalties or costs. For more informal visit the Department of Natural Resources <br /> U <br /> wetlands identification web page or Contact a Department of Natural Resources service center. U <br />