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Burnett County 7410 County Road N,No. 102, Siren,WI 54072 Office of Zoning Administrator g er <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER TELEPHONF�; <br /> _ i a <br /> 17Gk,.c� .� W)oS,�Pd W(avfvl, p, bI'foslrt- 75283(n -SSSS � cA <br /> PROPERTY ADDRESS <br /> cl <br /> LEGAL DESCRIPTION L(JT� V <br /> MAILING ADDRESS F�o!/,,, C�. l��P�P Vcl�e 1'1'Ih SS/,2Y-7Yo3 _ f7 <br /> r <br /> TYPE OF PEFMIT(S): y� <br /> ❑Single Family Dwelling ❑ Garage/Accessory Structure ❑ Stairs ❑Commercial Building 5 N <br /> ,R(Addition ❑ Bunkhouse ❑ Filling/Grading Cl Commercial Addition <br /> Deck ❑ 59.6921(1v)Gazebo (/��•, nn ❑Camping Unit ❑Commercial Aa. Structure E <br /> SIRUCTURE(ADOITION USE: bee x, f� /�; MI,1 _ 1J,u n•�T 3-J tc.n+.� l OrG� Q Z <br /> (H;Commercial siness; Bedroom;Deck;etc.) y ° <br /> BUILDING CONTRACTOR: �rl r%I(,)S <br /> r � <br /> n y ln� a <br /> PLOT PLAN---INCOMPLETE OR ILLEGIBLE PLOT PLANS,W=BE RETURNED, <br /> y o rd <br /> *a'REOUIRED PLOT PLAN INFORMATION*"` <br /> ❑ S/e"X 11"SHEET OF PAPER DISTANCE(IN FEET)TO: �y <br /> ❑ DRAWN TO SCALE OR DISTANCES LABELED ❑ WELL F <br /> ❑ PROPOSED BUILDING/STRUCTURE LOCATION ❑ SEPTIC TANK&DRAINFIELD ty <br /> 4Dmensions&Heights ❑ ROAD RIGHT-OF-WAY IF SURVEYED c�P I J, <br /> LI <br /> ❑ D(ISTING BUILDINGS/STRUCTURES(Includes deck, porch,etc) 4CENTERLINE IF NOT SURVEYED I ) <br /> Dimensions&Heights ❑ ALL PROPERTY LINES o <br /> ❑ NORTH ARROW ❑ ORDINARY HIGH WATER MARK �. <br /> _ <br /> y 1 <br /> NOTE: Bulloing/sWre ati <br /> [Mlocation must be staked for onsite verification <br /> ALL WETLAND AREAS <br /> n when needed. ����IJJJr�((�/����, r('��� nMrf .�J s <br /> THIS PERNIMS SUMECT TO ALL CONDITIONS LISTED BELOW: LCl� ENE D s <br /> • Removal or cutting of Veer and vegetation Is restricted along shoreline �[ V Lt� — <br /> • No structures(including retaining walls,etc.)are allowed unless specifically pe III'r}• <br /> • No filling,gmding, or shore land alterations are allowed unless specifically perm OCT 7 2014 <br /> • Driveway must meet width requirements within 60 days of permit E' <br /> • Accessary structurelgarage permits allow for prlvale residential storage only <br /> *•Not to be used for human habitation or rental storage'* n <br /> BURNETT COUNTY � I� <br /> [declaa tlu[MIs appllution(Nd Wing any acmmporAo examined ow <br /> nyirq sedule)hbeen emined by ma amy knledq and <br /> belief itis Wq]orreR ata mmpleta. I x nowlodq Mat I am reepdWble for the amen and a ui acy of all Information contained In <br /> this application(iMl Wing any accom,am on, schedule)and I former dedam•Mrt I merognipe Mat this information p waded will be <br /> ,died upon by me County of Bumett Wiacondn in determining whether to ivue a permit I former acre all liability Mat may be a <br /> moult of om County of Bumett relying on Mie information I am providing In di application. I agree In Permit county officials charged f <br /> ad h admhdsbaMy onunty ordinance or emu auMo,iaed peraons no have ace®to the above-descmibed premise at any reasonable <br /> none rpm M.wrpw or imyettian. <br /> r <br /> --ADDITIONAL CONOTIIONS... S Q AI LT <br /> zm " CeO � <br /> Ex15 AO-, p2rvY To n°E Adrl)1ovEtl s/s!/za/s, #lS3g� 3� <br /> 5TRuc-TU L29S -79 BE �S �FRoM THE 6Ah'1URR F ,Yu•H <br /> GORTMAAK(OHIPM), a ' soof <br /> on <br /> S �E£,i l siP�rcnon/ gs" <br /> g Sjm O /�S <br /> p /S /9 <br /> OWIUE 5 SIGNATURE mow <br /> 6k) , I�FIrG.YG/.rJ If. VT!/ 'G r ; c § 888 <br /> Egti <br /> E E 6. . rn <br /> ZONING OFFICIAL�� <br /> ••TON/UDC PERMITS MAYBE REQUIRED ••THIS PERMIT SHALL W <br /> IXRE ONE YEAR FROM DATE OF ISSUANCE <br /> W <br /> You are responsible for compying with state and federal taws concerning construction near or on wetlands, takes, and streams. <br /> Wetlands that are not associated with open water can be difficult to identify. Failure to comply may result In remonal or modifkatbn y <br /> N consorn that violates the law or other Penalties or coos. For more Information visit the Department of Natural Resources Z 8 o U 8 <br /> wetlandscoofifiotion web page or contact a Department of Natural Resources servke renter. `" <br />