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Burnett County 7410 County Road R, No. 102, Siren,WI 54872 Office of Zoning Administrator G <br /> APPLICATION FOR LAND USE PERMITS <br /> a <br /> OWNER FTELEPHONE yrs-sdo - �o, s oo � <br /> PROPERTY ADDRESS <br /> LEGALDESCRIPTION S Cavfa:+ ES f�r'�PS <br /> MAILING ADDRESS <br /> 3i4,Yb/ <br /> TYPE OF PERMIT(S): <br /> Single Family Dwelling ❑ Garage/Accessory Structure ❑ Stairs I ❑Commercial Building <br /> ❑ Addition ❑ Bunkhouse ❑ Filling/Grading ❑ Commercial Addition <br /> ❑ Deck ❑ 59.692(ly)Gazeta Cl Camping Unlit ❑ Commercial Acc Structure 9 <br /> STRUCTURE/ADDITION USE: '/ oAl'r <br /> z <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <br /> //�+ 'a <br /> BUILDING CONTRACTOR: l- V" �/ 66e/ � <br /> S L/IC - /�Q�l I 5i7Y1 O � O �a <br /> 55 ` n <br /> PLOT PLAN ---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETUFINED. rn z <br /> "'REOUIRED PLOT PLAN INFORMATION*** m <br /> ❑ 80/h"X 11"SHEET OF PAPER DISTANCE(IN FEET)TO: d <br /> ❑ DRAWN TO SCALE OR DISTANCES LABELED Cl WELL <br /> ❑ PROPOSED BUILDING/STRUCTURE LOCATION ❑ SEPTIC TANK&DRAW FIELD _ <br /> Dimensions& Heights Cl ROAD RIGHT-OF-WAY IF SURVEYED u <br /> ❑ EXISTING BUILDINGS/STRUCTURES(Includes deck, porch,etc.) 4CENTERLINE IF NOT SURVEYED <br /> -)Dimensions& Heights ❑ ALL PROPERTY LINES o V <br /> Cl NORTH ARROW ❑ ORDINARY HIGH WATER MARK �. <br /> ❑ AWETLAN^D AREAS <br /> NOTE: Building/structure location must be staked for onsite vend d6catim when needed. It <br /> �� l!THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: U• Removal or cutting of trees aa vegetation is restricted along shoreline AUG -.1 2014• No Structures(including retaining walls,etc.)are allowed unless specifically parni {hJ <br /> • No filling,grading, shore land alterations are allowed unless specifically para <br /> • Driveway must meet width requirements within 60 days ofpe <br /> prirmit I BURNM COUNTY <br /> • Accessory structure/garage permits allow for vate resitlential storage only e <br /> •-Not to be used for human habitation or rental stooge" ZONING <br /> z <br /> I declare Nat this application(including any accompanying schedule)has been examined by me and to the beat of my knowledge and <br /> belief it is true,correct and complete. 1 acknowledge Nat I am responsible for Ne detail and accuracy of all information contained In <br /> _this application (including any accompanying schedule)and 1 further declare that 1 recYgnize that this information provided will be <br /> noted upon by the County of Burnett Wisconsin in determining whether to issue a permit I further accept all liability Nat may be a <br /> result of the county of Burnett relying on this information l am providing in this apPlicatiin. l agree W permit county officials charged S <br /> with administrating county ordinances or other authorized persons to have access to Nejabove-described premises at any reasumple <br /> time for the purpose of inspection. <br /> -n > nno91 <br /> ---ADDITIONAL CON��D//.I.TIONlS�-- / / x v, ' <br /> /p/z.l -!y' OIJroDinS ne.�- ,fi �- 3 �Liaw��•.fc 'f t�r.•t// set 2 z -ti ' <br /> ac(�J'zssyv� Sa. ,{rrry wildl m= <br /> OWNER'S SIGNATURE //Q 31 >.a r <br /> ZONING OFFICIAL <br /> (date) c: — <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 /> WetialWs Nat are not associated with open water can be difficult to identify. Failure to comply may result in removal or modification 8` <br /> of construction that violates the law or other penalties or costs. For more information visit the Department of Natuol Resources <br />_ wetlands identification web page or contact a Department of Natural Resources service center. <br />