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_ - r <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator � G_ <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNERTELEPHONE - 2. tl� <br /> ade,r �150 dal - 7a(o3 <br /> PROPERTY ADDRESSa� <br /> �a622 Jotirgson Roams) �retleyi'c / Wt II((rpyh,JvJ' <br /> LEGAL DESCRIPTION <br /> � <br /> MAILING ADDRESS <br /> „"74 7g <br /> nZ -7— <br /> TYPETYPE <br /> OF PERMIT(S): <br /> ❑ Single Family Dwelling ❑ Garage/Accessory Structure W Stairs ❑ Commercial Building <br /> ❑ Addition ❑ Bunkhouse ❑ Filling/Grading ❑ Commercial Addition <br /> ❑ Deck ❑ 59.692(ly)Gazebo ❑ Camping Unit ❑ Commercial Act. Structure I_ 3 <br /> STRUCNRE/ADDITION USE: <br /> ���IIILL-FJ A <br /> (Home/Cabin;n;Commercial Business; Bedroom; Deck;etc.) /�'tT�.� 1,, p <br /> BUILDING CONTRNCTOR:�a�y —IU,01� w L-t/I 'Sli'llc2bl <br /> PLOT PLAN---INCOMPLETE OR ILLEGIBLE PLOT PLANS W=BE RETURNED. <br /> ***REOUIRED PLOT PLAN INFORMATION*** <br /> ❑ Byz”X 11"SHEET OF PAPER DISTANCE(IN FEED T0' _ <br /> Cl DRAWN TO SCALE OR DISTANCES LABELED ❑ WELL 1 <br /> (3 PROPOSED BUILDING/STRUCTURE LOCATION ❑ SEPTIC TANK&DRAINFIELD \ <br /> -)Dimensions&Heights _ O ROAD RIGHT-OF-WAY IF SURVEYED <br /> ❑ EXISTING BUILDINGS/STRUCTURES(Induces deck, porch,etc.) - -)CENTERLINE IF NOT SURVEYED '� <br /> -)Dimensions&Heights _ ❑ ALL PROPERTY LINES = <br /> ❑ NORTH ARROW ❑ ORDINARY HIGH WATER MARK <br /> t <br /> ❑ ALL WETLAND AREAS <br /> NOTE: Building/structure lotab.must be staked for onsite verification when needed. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: I tLJ <br /> Removal or cutting of trees and vegetation is restricted along shoreline <br /> No structures(including retaining walls,etc.)are allowed unless speclfically permitted <br /> No filling,grading,or shore land alterations are allowed unless specifically permitted 1 <br /> Driveway must meet width requirements within 60 days of permit g Z <br /> Accessory slmaure/garage pemlits allow for private residential storage only IIN^1-I <br /> **Not to be used for human habitation or rental storage'"— <br /> thief it is true,correct ng complete. I yang auudge flat 1 am responsible br m detail and acaurary or all inrotion pr milea will <br /> in Q <br /> Mia app on by he county of B Burnett <br /> hoomi n in dimshile)and 1 rormer declare mM I rend. If mM this Inromatbil y that m will be <br /> result upon by Me County of mlyin wn this in in determining woemer to isue a pkatio [hoer accept all liability flat i ch rile a <br /> resultdmin County co Burnettrelying on this information lam Providingha in mosapplimhe Iagree to per mit countyt any sdonall <br /> wiM a it the b ri county ordinances or otlrer autlwrized perwna M M1ave a¢ess m Me atovedesaibed premixs at any reazonatk <br /> time ror Me pumaae of inspection. <br /> --ADDITIONAL CONDITIONS D E V O D rr n n 3 e�� <br /> -- O <br /> JUL 21 2014 ' =.2 a - <br /> > G <br /> BURNETTCOUNTYo <br /> ZONING" >NwsN <br /> OWNER'S SIGNATURE N/ - -r'" 7/Ij 1y <br /> (date) <br /> ZONING OFFICIAL � 7,e <br /> V C <br /> (doe) 5 <br /> '"TOWN/UDC PERMITS MAYBE REQUIRED *'THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ' - - <br />