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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administratorbe <br /> - G <br /> APPLICATION FOR LAND USE PERMITS - <br /> _ yyya <br /> OWNER L <br /> lip TELEPHONE <br /> PROPERTY ADDRESS Q/i n eR L/ I� I' k \ I U 0 <br /> LEGAL DESCRIPTION r IFYGJ��r91 <br /> MAILING ADDRESS I =6• V �1 <br /> ��( nle) CA !� (�OP ) :5 <br /> TYPE OF PERMIT(S): <br /> Cl Single Family Dwelling ❑ Garage/Accessory Structure ❑ Stairs ❑ Commercial Building <br /> Wddition ❑ Bunkhouse ❑ Filling/Grading ❑ Commercial Addition <br /> ❑ Deck 1U1 59.692(ly)Gazebo ❑ jCamping Unit q J,❑I/Commercial Act Structure z � <br /> STRUCTURE/ADDITION USE: l.I f� rya h1f111�V�,\ z <br /> �—{— <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; <br /> BUILDING CONTRACTOR: ��\ �N SO {� Clr7 TJ l�Q`7 tV L 0 <br /> r <br /> On <br /> PLOT PLAN --- INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. I 1 z <br /> _ d <br /> "'REOUIRED PLOT PLAN INFORMATION"* <br /> Cl B'/z"X 11"SHEET OF PAPER DISTANCE(IN FEET)TO: 9 <br /> ❑ DRAWN TO SCALE OR DISTANCES LABELED ❑ WELL <br /> ❑ PROPOSED BUILDING/STRUCTURE LOCATION ❑ SEPTIC TANK& GRAINFIELD t p ' <br /> 4Dimensions&Heights Cl ROAD RIGHT-OF-WAY IF SURVEYED <br /> Cl E(ISTING BUILDINGS/STRUCTURES(Includes deck, porch,etc.) -)CENTERLINE IF NOT SURVEYED <br /> 4Dimens ons&Heights ❑ ALL PROPERTY LINES o <br /> Cl NORTH ARROW ❑ ORDINARY HIGH WATER MARK E <br /> ' SJ <br /> ❑ ALL WETLAND AREAS L <br /> NOTE: Building/stmcture location must be staked for onsite verifcation when needed. i I„ \ I) <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: D <br /> • Removal or cutting of trees and vegetation is restricted along shoreline <br /> • No structures(including retaining walls,etc.)are allowed unless speori ally pera <br /> • No filling,grading,or shore land alterations are allowed unless specifically permitted SEP 2'4 2014 <br /> • Driveway must meet width requirements within 60 days or permit 1 <br /> • Accessory structure/garage permits allow for private residential storage only BURN " <br /> 'Not to be used for human habitation or rental storage" ETT COUNTY ❑ z <br /> I declare that this application(including hedule has been examined b IA <br /> pp (int I any accompanying that <br /> se ) y a and to of bort pf my knowledge and _ <br /> belief if is true,correct and complete. I acknowledge Iha[I am responsible for the detail and actuary of all inbrmation contaw it in <br /> this application(including any accompanying schedule)and I further declare that I recognize that Nis inbrmation provided will be <br /> relied upon by the county of Burnett Wisconsin in determining whether to issue a permit. I further accept all liability that may be a <br /> result of the county of Burnett relying on this information I am providing in this application. l agree N Permit county officials charge F <br /> with adminirtrating county ordinances or other authorize persons to have access W the above-0escribed premises at any reasonable <br /> time for the Purpose of inspection. _ <br /> ,� •q > nr] nn6 �. <br /> --ADDITIONAL CONDITIONS-- x H n 3 3 a - <br /> _ P ' _ <br /> T r <br /> OWNER'S SIGNATURE <br /> o o ' — <br /> (date) __ _ ' ' " _ r <br /> ZONING OFFICIAL ..•-� 9 z9 Z�� - �'' F � T r <br /> ' (dace h c - <br /> --TOWN/UDC PERMITS MAYBE REQUIRED -*THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE _You are responsible for complying with state and federal laws conceming construction near or on wetlands, lakes, and streams. —_ <br /> Wetlands that are net associated with open water can be dimwit 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 Ne Departm¢nt of NaN21 Resources _�'^ ,",. H <br /> wetlands identification web page or contact a Department of Natural Resources service center. <br />