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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator r <br /> ^ APPLICATION FOR LAND USE PERMITS <br /> OWNER TELEPHONE `�ICJ)J /�lI J/� C <br /> I(•J OL�1 -(- l([I <br /> R <br /> PROPERTY ADDRESS <br /> 1 y <br /> LEGAL DESCRIPTION1: � <br /> 1 <br /> MAILING ADDRESS aL33^ � V'IL _5YFOS <br /> TYPE OF PERMITS): <br /> 0 1 <br /> \\/I v :r <br /> Cl Family Dwelling Ly�Garage/Accessory Structure ElStairs ❑Commercial Building <br /> ❑ Addition ( Bunkhouse ❑ Filling/Grading ❑ Commercial Addition <br /> ❑ Deck /�❑I59.692(ly)Gazebo L3 Camping Unit ❑Commercial Am Structure <br /> TL <br /> STRUCTURE/ADDITION USE: C�rhii J(:::o 6EE24-0_/W 1. a' z <br /> (Nome/Cabin;Camrghrrial Business; Bedroom; Deck;etc.) <br /> z <br /> BUILDING CONTRACTOR: O <br /> r <br /> r � <br /> f <br /> SLOT PLAN --- INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. zzy <br /> ***REQUIRED PLOT PLAN INFORMATION*** <br /> Cl81/z"X 11"SHEET OF PAPER DISTANCE(IN FEET)T0: o <br /> ❑ DRAWN TO SCALE OR DISTANCES LABELED Cl WELL Ji <br /> ❑ PROPOSED BUILDING/STRUCTURE LOCATION Cl SEPTIC TANK&DRAINFIELD <br /> -)Dimensions&Heights ❑ ROAD RIGHT-OF-WAY IF SURVEYED <br /> ❑ EXISTING BUILDINGS/STRUCTURES(Includes deck, porch,etc.) 4CENTERLINE IF NOT SURVEYED - <br /> 413imensions&Heights Cl ALL PROPERTY LINES <br /> ❑ NORTH ARROW ❑ ORDINARY HIGH WATER MARK <br /> ❑ ALL LAND AREAS <br /> NOTE: Building/structure location must be staked for onsite verification when needed. <br /> ILrS� U ILS} D I -"I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> • Removal car cutting of trees and vegetation is restmi along shoreline I 1 1 <br /> • No structures(including retaining watts,etc.)are avowed unless specifically permitted AUG 2 6 2014 W <br /> • No filling,grading,or shore land alterations are allowed unless spedfrally tted <br /> permi _ <br /> • Driveway must meet width requirements within 60 days of permit BURN QQ(f <br /> • Accessory structure/garage permits allow for private residential storage only ETT N'nr a <br /> --Not to be used for human habitation or rental storage*• ZONING n z <br /> I dlam Nat this application(including any accompanying schedule)has been examiner)by me and to the bettor my knowledge and I� <br /> belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy,of all information contained in p(V <br /> this application(including any accompanying actua le)and 1 further declare that I recognize that this information provided will be <br /> relied urban by the county of Burnen Wisconsin in determining whether to Issue a permit. 1 further accept all liability that may m a <br /> result of Me county of Burned,relying an this information I am providing in this application. l agree to permit county officials charged <br /> with administrating county ordinances or other authorized persons to have access to the above-0esonted premises at any reasonable <br /> time for the purpose of inspection. <br /> r; +fannnnag <br /> ---ADDITIONAL CONDITIONS--- <br /> OWNER'SSIGNATURE <br /> (date) c 3 R <br /> ZONING OFFICIAL �>� $ Z7 <br /> d ) 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 /> Wetlands that are not associated with open water can be difficult to identity. Failure to comply may result in removal or modifludon a a <br /> of construction that violates the law or other penalties or costs. For more information visit the Department of Natural Resources C 8 <br /> wetlands identification web page or contact a Department of Natural Resources service center. <br />