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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator 3 C <br /> APPLICATION FOR LAND USE PERMITS - <br /> OWNER -f / TELEPHON7QAleco 61.4t ,t '4. 6$76 - Z 2-/1 <br /> PROPERTY ADDRESS <br /> 72/ 7 <br /> z/ 7 LGo Yj)ruh,e F 72 r rJ £ <br /> LEGAL DESCRIPTION <br /> Tu / Al 2140 <br /> /-7 L CS/H V i6C I <br /> z <br /> MAILING ADDRES W � SY Q �� 1 <br /> � t3G f2V Gl V b <br /> TYPE PS): <br /> LJSinin glee Family DwellingGarage/Accessory Structure EIStairs ElCommercial Building <br /> ❑ Addition ❑ Bunkhouse ❑ Filling/Grading ❑ Commercial Addition a <br /> ❑ Deck ❑ 59.692(ly)Gazebo ❑ Camping Unit// ElCommercial Acc. Structure 3 <br /> STRUCRIREJADDMON USE: 7 K 2 N y L R f h6< cu r rQ 1cP / S/A F C U£/l H H NW <br /> (Home/Ca in;Coo�mmercial Business;Bedmorn; Deck;etc.) i <br /> STF✓E Kossct/ <br /> BUILDING CONTRACTOR: oC <br /> r <br /> r <br /> PLOT PLAN---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. z <br /> ***REOUIRED PLOT PLAN INFORMATION*** M <br /> ❑ 81/2"X 11"SHEET OF PAPER DISTANCE(IN FEET)TO: el <br /> N o <br /> ❑ DRAWN TO SCALE OR DISTANCES LABELED ❑ WELL I W <br /> ❑ PROPOSED BUILDING/STRUCTURE LOCATION ❑ SEPTIC TANK&DRAINFIELD I <br /> 46 Dimensions&Heights ❑ ROAD RIGHT-OF-WAY IF SURVEYED <br /> ❑ EXISTING BUILDINGS/STRUCTURES(Includes deck, parch, etc.) 6CENTERLINE IF NOT SURVEYED <br /> 6Dimensions&Heights ❑ ALL PROPERTY LINES o ) <br /> ❑ NORTH ARROW ❑ ORDINARY HIGH WATER MARK 5. w <br /> ❑ ALL WETLAND AREAS o <br /> NOTE: Building/stmaure location must be staked for onsite venfcabon when needed. <br /> I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: t <br /> • Removal or cutting of trees and vegetation is restricted along shoreline I� I <br /> • No structures(including retaining walls,etc.)are allowed unless speaFlcally pemlitted III fY- <br /> • No Filing,grading,or shore land alterations are allowed unless swifoally permitted <br /> • Driveway must meet width requirements within 60 days of permit <br /> • Accessory structure/garage pemlits allow for private residential storage only <br /> Not to be used fa human habitation or rental storage** `= r� <br /> 1 declare that this application(including a n schedule has been examined b m and N the best of m knowledge and <br /> pp ( 9 acknowledge <br /> that <br /> 9 ) Y e Y 9 <br /> his a it is true,correct and complete. 1 yang schedule) <br /> that I am responsible far the detail and accuracy s i a0 information ided ill in <br /> his application(including any accompanying mM1etlule)antl t further declare Na[I recognize Nat this information provided will be <br /> ..it upon by un countyofBuroett Wisconsin indeterminingraionam whether in Issue a PermiC [further accept all liability Nat may be a <br /> with administrating <br /> Ne County or Burnett relying on other uthoBon l am ons to m,inhake Nle application.Me a. ve-dee N Permit county officialsyreasonable E <br /> with administrating co insY ordinances or omen authorized persons[o have access N Ne above-0eurtbed premises at any reasonable <br /> time for Ne purpose or insPeRion. ^��ry str� � p ^ r. ? o n ) G <br /> ---ADDITIONAL CONDITIONS--- D EC <br /> \tUNIILL' D F w a 3 f V <br /> �"' 7ID FQOM !2u✓ .c > re 3 <br /> UTAST (Z MW,7jjvrg . JUL - 8 2014 =cc � _ <br /> BURNETT COUNTY � n 'Lu <br /> ZONING _ <br /> OWNER'S SIGNATURE <br /> (date) T y E R <br /> ZONING OFFICIAL li su>•_ �at ` P F <br /> (oath) <br /> --TOWN/UDC PERMITS MAYBE REQUIRED **THIS PERMIT SHALL E% F. <br /> You <br /> ONE YEAR FROM DATE OF ISSUANCE - - <br /> You are responsible for complying with state and federal laws concerning construction near or on wetlands, lakes, and streams <br /> Wetlands that are not associated with open water can be difficult to identify. Failure to comply may result in removal or modification <br /> of construction that violates the law or other penalties or costs. For more information visit the Department of Natural Resources <br /> wetlands identiBwtion web page or contact a Department of Natural Resources service center. �� <br />