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Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> n APPLICATION FOR LAND USE PERMITS <br /> OWNER �aw\ L���fUYV� TELEPHONE <br /> PROPERTYADDRESS <br /> h <br /> ( O <br /> LEGAL DESCRIPTION _ <br /> 1 <br /> MAILING ADDRESS <br /> TYPE OF PERMIT(S): � <br /> ❑ Single Family Dwelling ' arage/Accessory Structure LJStairs ❑ Commercial Building — <br /> ❑ Addition Bunkhouse ❑ Filling/Grading ❑ Commercial Addition <br /> ❑ Deck ❑ 59.692(ly)Gazebo ❑ Camping Unit ❑ Commercial Acc. Structure <br /> STRUCTURE/ADDITION USE: gI1JfA,�l LU•�1� - o <br /> `(Home/Cabin;Commercial Business; Bedroom; Deck; etc.) <br /> A <br /> BUILDING CONTRACTOR: O <br /> r <br /> PLOT PLAN ---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> ***REQUIRED PLOT PLAN INFORMATION*** <br /> J <br /> ❑ BYz"% 11"SHEET OF PAPER DISTANCE(IN FEET)TO NJ � I <br /> ❑ DRAWN TO SCALE OR DISTANCES LABELED ❑ WELL <br /> ❑ PROPOSED BUILDING/STRUCTURE LOCATION ❑ SEPTIC TANK&DRAINFIELD _ 1 <br /> 4Dimensions&Heights Cl ROAD RIGHT-OF-WAY IF SURVEYED (1J <br /> ❑ EXISTING BUILDINGS/STRUCTURES(Includes deck, Porch,etc.) 4CENTERIINE IF NOT SURVEYED '- <br /> -)Dimensions&Heights ❑ ALL PROPERTY LINES 1 <br /> ❑ NORTH ARROW ❑ ORDINARY HIGH WATER MARK 9. <br /> ❑ ALL WETLAND AREAS AI <br /> NOTE: Building/structure location must be staked for onsite verification when needed. <br /> unlp fC�[ OdE e c7 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: _ <br /> • Removal or cutting of trees and vegetation is restricted along shoreline <br /> • No structures(including retaining walls,etc.)are allowed ess specifically permitt OCT 1 2014 m <br /> • No filling,grading,or shore land alterations are allowed unless speoficzlly permitted T <br /> • Driveway must meet width requirements within 60 days of permit ,I, O <br /> • Accessory structure/garage permits allow for private residential storage only rt w <br /> **Not to be used for human habitation or rental storage** BURNETT COUNTY n 4J <br /> ti F <br /> I declare that this application(including any accompanying schedule)has been examinee by me dna d dMe Bert of my knowledge and <br /> h i f it is true,mrreLt and complete. I acknowledge that r am responsible mr de detail arM accumq of all information contained in <br /> this application (including any accompanying schedule)and I further declare that I recoze that gnithis inrm <br /> foation provided vzill be <br /> relied upon by Me County of Burnett Wisconsin in determining whether to issue a permit. I harder accept all liability that may be a <br /> result of me County o/Burnett relyhg on this information I am Providing in this application. I agree to Permit county officials charged _ <br /> with administrating county ordinances or other authorized Persons to have access to the above4escribetl premises at any reasonable - <br /> timefordePurposeorinsl tion. <br /> p '+190 (]rl L] n0 <br /> ---ADDITIONAL CONDITIONS--- 2 <br /> $� m >c, <br /> D ¢ <br /> U� 'P <br /> Nm <br /> n oz <br /> OWNER'S SIGNATURE I n <br /> ZONING OFFICIAL <br /> are) 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 fetleral laws concerning col>strucfion near or on wetiantls, lakes, and streams. <br /> Wetlands 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 <br /> wetlands identification web page or contact a Department of Natural Resources service center. o=o o <br />