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r <br /> 'Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER _'SE RRY W . 66 L TEIEPHONE '1�2,'������ � ,J S <br /> PROPERTY ADDRESS 2 /-j—( � / V JC U I� !/I y v� 0A� V 5gfzW ( �1.f*30 O <br /> l lO SQL <br /> LEGAL DESCRIPTION l.J ? 17Lor I C-5^ P2-V9 3W 83( l <br /> ev LV 1- i 5lae 1 2. r ill w rJEi N 1/2- IV l7 <br /> MAILING ADDRESS <br /> `J dk}fE p•S t, T3Ost'. t <br /> TYPE OF PERMIT(S): <br /> LI Single Family Dwelling ❑Garage/Accessory Structure ds ins Cl Commercial Building' <br /> Cl Addition ❑ Bunkhouse ❑ Filling/Grading ❑ Commercial Addition <br /> ❑ Deck ❑ 59.692(ly)Gazebo C3 Camping Unit C3 Commercial Acc. Structure <br /> STRUCTURFJADDI-PION USE: <br /> �n/ �lekk as <br /> (Home/Cabin;Com0yercial Business; Bedroom;Deck;etc. C <br /> A <br /> BUILDING CONTRACTOR: O/fr O <br /> 'LOT PLAN •--INCOMPLETE OR ILLEGIBLE PLOT PLANS 3=BE RETURNED. 'a� 3 z <br /> ""REOUIRED PLOT PLAN INFORMATION... <br /> ` <br /> B 81h"X 11"SHEET OF PAPER DISTANCE(IN FEET)T0: <br /> ❑ DRAWN TO SCALE OR DISTANCES LABELED ❑ WELL <br /> ❑ PROPOSED BUILDING/STRUCTURE LOCATION ❑ SEPTIC TANK&DRAINFIELD v <br /> 4Dimensions&Heights ❑ ROAD RIGHT-OF-WAV IF SURVEYED <br /> ❑ EXISTING BUILDINGS/STRUCTURES(Includes deck, porch,etc.) 4CENTERLINE IF NOT SURVEYED IllpCOLi . _ <br /> 4Dimensions&Heights ❑/ALL PROPERTY LINESo )� <br /> NORTH ARROW 1Y ORDINARY HIGH WATER MARK �. <br /> l <br /> ❑ ALLWETLANDAREAS o <br /> NOTE: Building/structure location must be staked for ollsi[e verifcatlon when needed. � r <br /> THIS PERMIT IS SUB]ER TO ALL CONDITIONS LISTEDBELOW: <br /> cutting ������ D <br /> Removal or cung of trees and vegetation is resMctlb along shoreline I <br /> • No structures(inducing retaining walls,etc.)are aimed unless specifically permitt <br /> AUG 2 2 2014 <br /> • No filling,grading,or sore lam alterations are allowed unless spedfically peri <br /> • Driveway must meet width requirements within 60 days of permit <br /> • Accessary structure/garage permits allow for private residential storage only e z <br /> "Not to be used for human habitation or rental storage" BURNETT COUNTY n <br /> z <br /> I de lare Mat this application(Inluding any accompanying schedule)has been examined by has and M e o y knowledge and <br />—huller It b true,correct and complete. I xMnowled"net I am responsible for the detail and accmnq of all Mfomution contained In IIS/ <br /> Mle application(including any accompanying schedule)and I further declare that I recognise Mat this information'previded will W <br /> relied upon by the County of Burnett Wisconsin in determining whether W Issue a permit. I further accept all liability that may be a <br /> result of Me County of Burnett Mying en MIs Infom n I am pr Uing In MIs appllunon I spree to permit county onidals larged `< <br /> with administrating county ordinances or other authodaed persons to have amss to Me above-0ezvibed pnmlus at any reasonable <br /> time for the purpose of inspectlon. <br /> nq ` 9 <br /> ---ADDITIONAL CONDITIONS--- 9 <br /> i1 Cig� '^vi^ <br /> o `E � S <br /> ,–I 2 <br /> OWNER'S SIGNATURE <br /> ZONING OFFICUL <br /> (da ) k a a <br /> . <br /> 'TOWN/UDC PE S MAV BE REQUIRED IS PERMIT SMALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ? ' <br /> You are responsible for complying with state and federal laws concerning construcdon near or on wetlands, lakes, and strealrs. <br /> Wetlands that are not assodated with open water can he difficult to identity. Failure to comply may result in removal or modification <br /> of consbucuon that violates the law or other penalties or mss. For more information visit Me Department of Natural Resources <br /> wetlands identification web page or contact a Department of Natural Resources service center. <br />