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r <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 OfCe of Zoning Administrator - 7— <br /> APPLICATION <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER !' TELEPHONE <br /> 1A L2 �(, o f 6-C�- �4< `�9� ct <br /> PROPERTY ADDRESS br/0.7 11-A ( ."J IK �P L �h1 <br /> LUT-- <br /> � <br /> LEGAL DESCRIPTION I Ll�—77 I <br /> V 1/�7'13 <br /> -, <br /> Drfr <, \ ,u <br /> MAILING ADDRESS 7.,16-7( �u C n 'L �� �t=- - <br /> n � ���5�(11, 3 <br /> TY`P€OF PERMIT(S): !T <br /> TA Single Family Dwelling `JGarage/Accessory Structure LlStairs ❑ Commercial Building _ A" <br /> ❑ Addition ❑ Bunkhouse ❑ Filling/Grading ❑ Commercial Addition <br /> ❑ Deck Cl 59.692(l/y�)Gazebo ❑ Camping Unit Cl Commercial <br /> (Commercial Add. Structure <br /> TU <br /> STRUCRE/ADDITION USE: K //1'6lI^f� /v'�IP S�✓`� I- Z <br /> (Home/ bin;Commercial Business; Bedroom; Deck; etc.J I-- <br /> S <br /> BUILDING CONTRACTOR: nluvfl O ) <br /> - n <br /> PLOT PLAN ---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> ***REOUIRED PLOT PLAN INFORMATION... (,x, r <br /> ❑ 81/2"X 11"SHEET OF PAPER DISTANCE TIN FEET)TO: <br /> ❑ DRAWN TO SCALE OR DISTANCES LABELED ❑ WELL <br /> ❑ PROPOSED BUILDING/STRUCTURE LOCATION ❑ SEPTIC TANK&GRAINFIELD <br /> 4Dimensions& Heights ❑ ROAD RIGHT-OF-WAY IF SURVEYED <br /> ❑ EXISTING BUILDINGS/STRUCTURES(Includes deck, porch, etc.) ->CENTERLINE IF NOT SURVEYED <br /> 4Dimensions& Heights ❑ ALL PROPERTY LINESo Xz <br /> Cl NORTH ARROW ❑ ORDINARY HIGH WATER MARK = <br /> ❑ ALL WETLAND AREAS <br /> NOTE: Building/structure locafion must be staked for onsite verification when needed. /�IrLJ, L s <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: D VEP <br /> ) <br /> • Removal or cutting of trees and vegetation is restrictetl along shoreline Loa V 'L� l/ ILLS55 <br /> No structures(including retaining walls,etc.)are allowed unless specircally permitted <br /> • No filling,grading,or shore land alterations are allowed unless specifically permitted SEP 12 2014 _ O <br /> • Driveway must meet width requirements within 60 days of permit 'a <br /> • Accessory structure/garage permits allow for private residential storage only <br /> **Not to be used for human habitation or rental storage** BURNETT COUNTY <br /> A <br /> I declare that this application(including any accompanying schedule)has been examined by me antl to th nowletlge antl "' <br /> belief it is true,correct and complete. 1 acknowledge that I am responsible for the retail and accuracy of all information contained in 6 <br /> this application (including any accompanying schedule)and I further declare that I recognize that this information provided will be <br /> relied upon by the county of Burnett Wisconsin in determining whether to issue a permit. 1 further accept all liability that may he a <br /> cult of the county of Burnett relying on this information l am providing in this application. I agree to permit county officials charged <br /> with administrating county ordinances or other authorized Persons to haw access to the above-described premises at any reasonable <br /> time for the purpose of inspection. <br /> - 2 , 25g "., <br /> ---ADDITIONAL CONDITIONS- ,3, ' - <br /> 3 � <br /> OWNER'S SIGNATURE Z�— <br /> (d <br /> 0 0 - <br /> 6 <br /> ZONING OFFICIAL 91 0 <br /> (tla[e)zc <br /> 2 i fi - - <br /> **TOWN/UDC PERMITS MAYBE REQUIRED **THIS PERMIT SHALL EXPIRE 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 identification web page or contact a Department Of Natural Resources service center. <br />