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r <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator - C7 <br /> APPLICATION FOR LAND USE PERMITS - 7 L. <br /> ° <br /> OWNER TELEPHONE <br /> -b�z_vrn 63 -2 CGS o <br /> PROPERTY ADD SS O C"/2 - j /v y7 <br /> 0�6 ��i�$ D h �zC C«L�.✓ ,Z O <br /> /LEGAL DESCRIPTION <br /> MAILING ADDRESS ,%ps V'C �[— <br /> TYPE OF PERMIT(S): <br /> Single Family Dwelling -Garage/Accessory Structure ❑ Stairs ❑ Commercial Building �- <br /> ❑ Addition ❑ Bunkhouse ❑ Filling/Grading ❑ Commercial Addition <br /> CI Deck 1159.692(ly)Gazebo ❑.Camping.Unit _�.O.Commercial ACC Structure-- ' <br /> STRUCIURE/ADDITION USE: S�ALC�� - <br /> z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: <br /> PLOT PLAN ---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. 01 I z <br /> c _ <br /> ***REQUIRED PLOT PLAN INFORMATION*** <br /> y,1 E <br /> ❑ BYz`X 11"SHEET OF PAPER DISTANCE(IN FEET)TO IVB o <br /> ❑ DRAWN TO SCALE OR DISTANCES LABELED ❑ WELL <br /> ❑ PROPOSED BUILDING/STRUCTURE LOCATION ❑ SEPTIC TANK& DRAINFIELD s u- <br /> ->Dimensions& Heights ❑ ROAD RIGHT-OF-WAY IF SURVEYED .� <br /> ❑ EXISTING BUILDINGS/STRUCTURES(Includes deck, porch, etc.) ->CENTERLINE IF NOT SURVEYED <br /> Dimensions&Heights ❑ ALL PROPERTY LINES c) U} <br />_-�.:❑k-NnPTH,ARROW - _ �s�_. a- <br /> E] ORDINARY.HIGH WATER.NARK---- <br /> ❑ ALL WEILAND AREAS ly tr <br /> NOTE: Building/structure location must be staked for onsite verification when needed. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW:-"'• �Ad <br /> • Removal or cutting of trees and vegetation is restrictetl along shoreline D <br /> No structures(including retaining walls,etc.)are allowed unless specifcally perAUG Q 8 2014 <br /> • No filling,grading,or shore land alterations are allowed unless specifrally perm <br /> • Driveway must meet width requirements within 60 days of permit _ <br /> • Accessory structure/garage permits allow for private residential storage only BURNETT COUNTY <br /> "Not to be used for human habitation or rental storage** ZONING _ <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge and p <br /> belief it is true,correct and complete. I acknowledge that I am responsible far the detail and accuracy of all information contained in <br /> this application (including any accompanying schedule)and 1 harder declare that 1 recognize that this information provided will be <br /> relied upon by the County of Burned 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. 1 agree to permit county officials charged <br /> with administrating county ordinances or other authorized persons to have access to the above-described premises at any reasonable <br /> .Mime for the purpose of inspection. <br /> — rm > noon > - <br /> _ <br /> a <br /> ---ADDITIONAL CONDRIONS-- <br /> v - _��.._• ,- m > o <br /> T <br /> > ' z <br /> rP � z <br /> y <br /> o <br /> OWNER'S SIGNATURE y/yam/ _ > g co <br /> ZONING OFFICIAL - 9 3 Z.O - - d, <br /> dare) <br /> **TOWN/UDC PER ITS MAYBE REQUIRED **THIS PERMIT SHALL 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 /> Wetlarids that are not associated with open water can be difficult to identify. Failure to comply may result in removal or modification <br /> ur <br /> of constrution that violates Ne law or other penalties or costs. For more information visit the Department of Natural Resources <br /> wetlands id6ntlFl\wtion web page or contact a Department of Natural Resources service center. c - o <br />