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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 /> OWNER ,0-) TELEPHONE j/q/ <br /> PROPERTY ADDRESS -.5-1-7b !)WiL!; LL- <br /> LEGAL DESCRIPTION 1 <br /> -3S- r4V A/ R if, Ll CY b'_ 224 <br /> MAULING ADDRESS <br /> ceaq poig Jv' nciz Rol. ji'_-V/sg�4 U)i ' _002u— <br /> TYPE OF PERMITS): <br /> U Single Family Dwelling Q!Garage/Accessary Structure U Stairs 0 Commercial Building <br /> )(Addition U Bunkhouse U FiLing/Grading U Commercial Addition b i <br /> Q Deck ZI 59.692(tv)Gazebo Q Camping Unit U Commercial Act.Structure, <br /> Re <br /> STRUCTURE/ADDITION USE <br /> -,iness; "rL:mmn;back;einc.) 4 �C- <br /> BUILDING CONTRACTOR, 5e�P <br /> PLOT PLAN---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RIFTURNED. <br /> --�REOUIRED PLOT PLAN INFORMAIIQN**- <br /> • 81/,t"X 11"SHEET OF PAPER DISTANCE(IN FEET)M <br /> • DRAWN TO SCALE OR DISTANCES LABELED oeu WELL <br /> • PROPOSED BUILDING/STRUCTURE LOCATION tvl0d�b SEPTIC TANK&DRAINFIELD <br /> 4Dimensions&Heights U ROAD-OGKT-OF-WAY IF SURVEYED <br /> • EXISTING BUILDINGS/STRUCTURES(Includes deck, porch,etc.) CENTERLINE IF NOT SURVEYED <br /> 4Dimensions&Heights PROPERTY LINES <br /> • NORTH ARROW ORDINARY HIGH WATERMARK <br /> PU ALL WETILAND AREAS <br /> NOTE: Building/structure locotion must ho,staked!for onsite verification when needed. <br /> THIS PERMIT IS SUMECT TO ALL CONDITIONS LISTED BELOW: <br /> R moval or cutting of areas and segetstion is restricted along shoreline <br /> He moutures(including hetsining walls,etc.)am allowed unless specifically perinnitted <br /> No tiling,grading,or share land alterations are allowed unless sivenifically parnothed <br /> Driveway must meet width requirements within 60 dave of Pernat <br /> Aocievshy structure/garage purnats,allow for private rosidental storage only c5 <br /> -Not an be used for human habitation or rental storage- <br /> I dentine thart Has application(iWwlv any acsormanyin,selnedule),has been warranted!by me and W the beat of my knomakedge and <br /> baluer it is true,cerr�end complete. I arkinnowlevoge met I am re,bensible for ti detail and a,sturavoy of all finficernabon contained 11 <br /> this applitation(imsualm any accommartyind sidhedula)and I further declare pleilt I neennisre that this information provided-will the <br /> raile:upon by me county or Burnett wisconsina diamminin,whether to issuit a denraid. I further acteat.11 liability that may he. I <br /> nesult a me county be Burned,miyet,on this information I am prowifir,in"is appliention. I nined,to pernalt rownt,officials chargent <br /> with athainivonami;county ordinannoes or enter authorund persons to have access to the aone-deenten promises at an,redianable <br /> time far the ourome of insolietion. > > p <br /> ---ADDITIONAL CONDITIONS--- <br /> ot ' -a <br /> ECRY [I c, ' : <br /> ici�' cF > . . <br /> /i,10 vj4pe' JUL 2 1 201, <br /> *,Vb VjG)LIPladi TV 9i5 44WW�D X T's, <br /> st 12 <br /> BURNETTCOwn , HmM = <br /> 83 <br /> OWNERS SIGNATURE_d.,;I1.1i <br /> (date) <br /> _ 7 <br /> ZONING OFFICML c <br /> (date) <br /> TOWN/UDC PERMETS MAYBE REQUIRED ­1EHIS PERMIT SHALL EXPIRE ONE YEAR FROM DAme OF ISSUANCE <br /> y * I : , - <br /> on am responsible for samirying with state and federal laws concerning brinstruction near or on wetlands, lakes, and spears. <br /> Wetlands that are net assodaterl vath open water can be difficult to annually.Failure to comply may result in removal a,modiffi-tion <br /> of obvismushon <br /> that violates the law or other penalties or costs For more infornhation virst the Doinumnent of Natural R <br /> assurbas <br /> wetlands identification wato page or contact a Derbartmort of Natural uesaiumcos�somice mote.. <br />