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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator C <br /> APPLICATION FOR LAND USE PERMITS <br /> A <br /> OWNER TELEPHONE - <br /> PROPERTY DDRE55 - <br /> "3/02 /1160 ' LAKL' el OdNP,4 ay L7/5, 5Vf r <br /> LEGAL DESCRIPTION <br /> MAILING ADDRESS <br /> o <br /> r1a7 c. ,(wh ST MFhcR%O.viE 1„ i SY75S/ <br /> TYPE OF PERMIT(S): y ? <br /> Ll Single Family Dwelling T Garage/Accessory Structure ❑ Stairs ❑ Commercial Building <br /> X Addition ❑ Bunkhouse ❑ Filling/Grading ❑ Commercial Addition <br /> ❑ Deck ❑ 59.692(ly)Gazebo ❑ Camping Unit ❑ Commercial Acc. Structure ` <br /> STRUCTURE/ADDITION USE: y9 L <br /> � 5 '�a£Soy Y��J(?GG� .(— /)FZA C r>?Uf fi z <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <br /> � _ a <br /> BUILDING CONTRACTOR: LrZF. O <br /> T <br /> 7 <br /> PLOT PLAN --- INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. c � a <br /> ***REQUIRED PLOT PLAN INFORMATION*** m <br /> ' a <br /> ❑ 81/2"% 11"SHEET OF PAPER DISTANCE(IN FEET)TO, f� o <br /> D. DRAWN TO SCALE OR DISTANCES LABELED ❑ WELL <br /> 'd PROPOSED BUILDING/STRUCTURE LOCATION ❑ SEPTIC TANK& DRAINFIELD <br /> 6Dimensions&Heights ❑ ROAD RIGHT-OF-WAY IF SURVEYED <br /> ❑ EXISTING BUILDINGS/STRUCTURES(Includes deck, porch, etc.) 6CENTERLINE IF NOT SURVEYED <br /> ill,Dimensions& Heights ❑ ALL PROPERTY LINES o <br /> ❑ NORTH ARROW ❑ ORDINARY HIGH WATER MARK �. ) <br /> ❑ ALL WETLAND AREAS c ) <br /> NOTE: Building/strucure location must be staked for onsite verification when needed. F 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 01 <br /> r ~ 1 <br /> • Removal or cutting of trees and vegetation is restricted along shoreline <br /> • No structures(including retalrung walls,etc.)are allowed unless specifically permitted <br /> • No filling,grading,or shore land alterations are allowed unless specifically permitted <br /> • Driveway must meet width requirements within 60 days of permit <br /> • Accessory structure/garage permits allow for private residential storage only <br /> Not to be used for human habitation or rentalstorage*' <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge and <br /> belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information contained in Ul <br /> this application(including any accompanying schedule)and I further declare that I recognize that this information Provided will be <br /> relied upon by Me County of Burnett Wisconsin in determining whether to issue a Permit. I further accept all liability that may he a <br /> result of Me County of Burnett relying an this information I am Providing in this application. I agree M Permit county officials charged S <br /> with administrating county ordinances or other authorized persons to have access W the abase-described Premises at any reasonable <br /> time for the purpose of inspection. <br /> F, <br /> 1�44mmsJ. enno � c S' <br /> ---ADDITIONAL CONDITIONS-- D If CENE Dc' <br /> JUN 20 2014 <br /> BURNE17 COUNTY d G N <br /> � ZONING 3 <br /> OWNER'S SIGNATURE /` G— � — � ! n >� <br /> cry _. r <br /> (date) _ 3 - P, E = in <br /> ZONING OFFICIAL — - <br /> JS M (date) <br /> •`TOWN/UDC PER AY BE 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 /> Well 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 S <br /> wetlands identification web page or contact a Department of Natural Resources service center. ` <br />