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Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administrator G <br /> APPLICATION FOR LAND USE PERMITS -_ <br /> OWNER `M-' � S, e (-�TELEPMrdN .�0 �3 LA <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION <br /> O Cy3 <br /> (LL�Ti J V <br /> MAILING ADDRESS 6, Sc, <br /> TYPE OF PERMIT(S): <br /> ❑ Single Family Dwelling OCGarage/Accessory Structure ❑ Stairs ❑ Commercial Building <br /> ❑ Addition ❑ Bunkhouse Cl Filling/Grading ❑ Commercial Addition <br /> ❑ Deck ❑ 59.692(ly)Gazebo --\\ ❑ Camping Unit ❑ Commercial Acc. Structure <br /> STRUCTURE/ADDITION USE: - <br /> e <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: J QC C'LcsJ <br /> PLOT PLAN ---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. �_ r <br /> ***REOUIRED PLOT PLAN INFORMATION*** <br /> ❑ 8'/2"X 11"SHEET OF PAPER DISTANCE(IN FEET)TO: - <br /> ❑ DRAWN TO SCALE OR DISTANCES LABELED ❑ WELL - <br /> ❑ PROPOSED BUILDING/STRUCTURE LOCATION ❑ SEPTIC TANK&DRAINFIELD <br /> 4Dimensions&Heights ❑ ROAD RIGHT-OF-WAY IF SURVEYED v <br /> ❑ EXISTING BUILDINGS/STRUCTURES(Includes deck, porch, etc.) 4CENTERLINE IF NOT SURVEYED - 1 <br /> 1 • <br /> 4Dimensions&Heights ❑ ALL PROPERTY LINES - k/ <br /> ❑ NORTH ARROW ❑ ORDINARY HIGH WATER MARK i. ) <br /> ❑ ALL WETLAND AREAS _ <br /> NOTE: Building/structure location must be staked for onsite verification when needed. M D y <br /> ,? ZD <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: D -,JL4 _ <br /> • Removal or cutting of trees and vegetation is restrict( aloltg shoreline f I, <br /> • No structures(including retaining walls,etc.)are allowed unless specifically permi Sp 8 2014 -llp`\�llVt <br /> • No filing,grading,or shore land alterations are allow etl unless specif "" pennitt �f <br /> • Dm ay must meet width requirements w,Mln W days of permit L; <br /> • Accessory structure/garage permits allow for private residential storage only BURNETT COUNTYZI <br /> Net to be used for human habitation or rental storage•* ❑ t Cf <br /> ZONINGN, <br /> I declare Mit thisapplication <br /> correct <br /> and c mplete(Includ, I any accompanying et schedule)resp Ma leen exaMe detetl by meandcur to of Lest or at ocontained <br /> knowledge and <br /> befid in <br /> this application it Is We correct ana complete a yang scedpe Mat 1 am mbl ertdecla tot Me I rec and amrap of all matron pr wnminW in <br /> MIs lPony (including any Burnett <br /> Wisconsin <br /> n in dale) iii 1 hither declare that 1 recognize Izf that this ptomutrot m will a <br /> relief upon by Me County of Burnett *ns i sin in determining l am w idi r ra MIs a permit I further atter[all liability nto Mat may lea - - - <br /> withactMeeountyot unmoor retyhg on Mls it authorize[ proms herea capPllgtlon. Ieprce fo per premises <br /> ischarged <br /> reasonable <br /> with for Me purposes <br /> countyeoll mor oMez authorized persons W have access M Meabove-destHlM premises at any reasonable <br /> time for M<purpose M insptttian. = r:,- � � > G <br /> ---ADDITIONAL CONDTDONS-.. <br /> i5 <br /> ZZ +1 m m � 4 � ws <br /> OWNER'S SIGNATURE c f,_,r _„T•, <br /> (nate <br /> ZONING OFFICIAL 9 �O �� <br /> d al <br /> "TOWN/UDC PERMITS MAY BE REQUIRED "THIS PERMIT SMALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ' -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 difficut 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 Resconstruction - - <br /> wetlands identficimon web page or contact a Department of Natural Resources service center. r '8 - ' <br />