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Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Once of Zoning Administrator 3 <br /> APPLICATION FOR LAND USE PERMITS = p <br /> OWNER TELEPHONE <br /> 1 661tj�1lllkFi ..•W44 {`xa n/il"�l a III.WLI <br /> PROPERTYADD Q� <br /> 1 J <br /> LEGAL DESRUPTI W'V,^^ V (J_ P L T `fib <br /> ( O <br /> MAULING ADDRESSn101 L1 <br /> TYPE OF PERMIF(S): !� <br /> U Single Family Dwelling )a Garage/Accessory Structure U Stairs U Commercial Building g <br /> U Addition U Bunkhouse U Filling/Gading U Commercial Addition 5 <br /> U Deck U 59.692(ly)Gazebo D Camping Unit U Commercial Am. Structure <br /> STRUCTURE/ADDITION USE:1" �a/I`532^J-� ' <br /> j (Horre/Cahin;Cameroal Business;Bedroom;Deck;etc.) <br /> z <br /> _ BUILDING CONrPAQOR: OV ntz— <br /> PLOT PLAN---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. _ a <br /> O <br /> '*'REQUIRED PLOT PLAN INFORMATION"' <br /> ❑ 81h"% 11"SHEET OF PAPER DISTANCE(IN FEET TO: <br /> Cl DRAWN TO SCALE OR DISTANCES LABELED ❑ WELL <br /> U PROPOSED BUILDING/STRUCTURE LOCATION ❑ SEPTIC TANK&DRAINFIELD 1 <br /> ->Dimensions&Heights ❑ ROAD RIGHT-OF-WAY IF SURVEYED o ' <br /> U EXISTING BUILDINGS/STRUCTURES(Includes deck,porch,etc.) 4CENTERLINE IF NOT SURVEYED <br /> -�Dimensians&Heights ❑ ALL PROPERTY LINES c <br /> U NORTH ARROW U ORDINARY HIGH WATER MARK 2 1 <br /> U ALL WETLAND AREAS ;IrIrs�11.11' 1 <br /> NOTE: Buildiny/smRMm baton must be staked for orate venfiation when needed. F <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: <br /> • RertgvaI or cutting of trees and vegetation is nestndetl along sfwreh e r 1 <br /> • No strictures(including retaining walls,etc.)ale allowed unless sµnfially PEmlltbd <br /> • No filling,grading,or shore land alterations arc allowed unless speafially Pomtmd _ <br /> • Driveway must meet width requirements within 60 days of Permit <br /> Accessmy stmcLrte/garage pernnts allow for Private residential storage only n <br /> '-Not to be used for human habitation or rental storage•r n <br /> B <br /> I 4eCam met this mi anm( plete.lI any atLtenanyaP am <br /> has Men thamlred by l a air m ora best pf myn commknowledge a�in <br /> H:Pefnisburp mnect W maccomrMgstloopee)and <br /> I mthu dibk/ar Me aeonptl thatthisiall oinMrmtbnconbirca in <br /> miss applia6on(Indual arty accompanying smadule)eM I Nmler drdare met I reropnize that[FIs information proviBed will be <br /> aura upon b/tice Calla pl aprrett wbronsln In ERaminlnp wbener m Ipue a pemlK 3 Nrmer amM all IN41My ma[may be a — - .- <br /> rewh M me CpurKv'W Bpmelt Nybp pn rah iMpmlaHon I am provNirN in mk appliratbn. I egme o permH county dllckla charyetl S <br /> wim adminiztremg muni)'ordimncn v LRhb eumorbee <br /> / tl$m/erMu ctlw�U W nnoo-M. or INpKnpn. <br /> aesonamlwae �/ eacriIM$ana"reharrable <br /> ---ADDI1lONALCONDH10Ns— wnof" '/ Mn <br /> m <br /> S�Iof^er/%I c. dysturb�q�eq BURNETT COUNTY 5 w 9 <br /> ,,pl4Le. n ZONING <br /> n aN goo'bg � <br /> OWNER'S SIGNATURE iz <br /> 22y <br /> ZONING OFFICIAL <br /> ••TOWN/UDCe for coSMAYBEonREQUIRED <br /> and "al lam PERMITSHALLE%PI0.E ONE YEAR FROM DATE OF ISSUANCE _ <br /> You are rthat a n for saga yinq vdM state air (ideal laws concerning mnlure to c near or y r wetlands, tikes, and streams. <br /> Woti that are not asooaMe with open water an be r costs to identity.Failure to comply may result a removal or l Resa tion <br /> of construction that n web�olatos Page <br /> law or other Penalties o rash. l R mom is serwc on visit the Depamnent of Natural Resources <br /> wemnds idenGfrdtion web page or contact a Departrnent of Natual Resources servbe center. <br />