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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator 3 G <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNEROily �n TELEPHONE <br /> ' Jtnni7r NCFr/� S06-2i 7e <br /> PROPERTY ADDRESS 9r z/W, ,4 < �I;q 9 3 O <br /> LEGAL DESCRIPTION I^ 1 <br /> MAILING ADDRESS IW� I <br /> TYPE OF PERMIT(S): J <br /> ®Single Family Dwelling ❑ Garage/Accessory Structure L3 Stairs Cl Commercial Building {y <br /> ❑ Addition ❑ Bunkhouse ❑ Filling/Grading ❑ Commercial Addibon <br /> ❑ Deck ❑ 59.692(iv)Gazebo ❑ Camping Unit ❑ Commercial Act.Structure Z <br /> 3 <br /> STRUCTURE/ADDITION USE t z \Yrs' <br /> JL (Home/Cabin;Commercial Bu9ness; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: <br /> r n <br /> r �FC'�Jt�S <br /> PLOT PLAN ---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> **'REOUIRED PLOT PLAN INFORMATION*** <br /> ❑ 81h"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 9J <br /> -)Dimensions& Heights ❑ ROAD RIGHT-OF-WAY IF SURVEYED <br /> ❑ DUSTING BUILDINGS/STRUCTURES(Includes deck, porch, etc.) 4CENTERLINE IF NOT SURVEYED _ C I <br /> Dimensions&Heights ❑ ALL PROPERTY LINES o 1 <br /> ❑ NORTH ARROW ❑ ORDINARY HIGH WATER MARK _ I <br /> ❑ ALL WETLAND AREAS y <br /> NOTE: Building/structure location must be staked for onsite verification when needed. p J f ) <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTEDBELOW: n Ip'('/��,r���� <br /> Removal or cuMng of trees and vegetation is restricted along shoreline U Lss V D l�I <br /> • No structures(inducting retaining walls,etc.)are allowed unless spedtlaaiy p <br /> • No filling,grading,or shore land alterations are allowed unless specifically per It SEP 10 2014 <br /> • Driveway mus[meet width requirements within 60 days of permit <br /> • Accessory structure/garage permits allow for private residential storage only d <br /> "Not to be used for human habitation or rental storage' BURNETT COUNTY <br /> A <br /> I delete Mat this application and complete. I any a[mmpe that aam res o)bas bttn Me deutl by mean f at ono urron a and <br /> belief it is true,correct and nyaeo t acknowledge that I am responsible re Me detail and Oat this <br /> of all information provided! <br /> ill in III— KJ <br /> this d! upenoan (inducting any Burnett <br /> iicnq n in dee)and L further tlMare that t recognize Izf Mat[ac information y that tl will be <br /> relied upon by Me County of ournen Wisronsin in ration determining whether m issue a permit t further accessallliability that may be a <br /> result of Me County of Bumdt relying on or <br /> information t am ons toi have <br /> in this ss toapplualthon.ab t agree ri permit county officials chargee <br /> with for Me Purpose <br /> county ordinances or oMer auModzed persons to ham access to Ma above-0escribed premises at any reasonable <br /> One for Me purpose a1 inspection. <br /> n � > nn ^. nod, <br /> —ADDITIONAL CONDITIONS-- <br /> > x <br /> d n \ a _ <br /> > <br /> m g, w T <br /> m ' <br /> (LI ? "z <br /> OWNER'S SIGNATURE W�A_'/1 n <br /> da F 3 R <br /> ZONING OFFICGL �,,.--� `1 !S Zo/ <br /> date) — <br /> "TOWN/UDC PERMITS MAYBE REQUIRED "THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE - =_ <br /> You are responsible for complying win state and federal laws concerning construction near or on wetlands, lakes, and streams. n <br /> Wetlands that 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 me Department of Natural Resources — <br /> wetlands identification web page cr Contact a Department of Natural Resources service center. <br />