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Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administrator — ? G <br /> APPLICATION FOR LAND USE PER�MnIT�SG� y = Y <br /> OWNF"�^ 1 ` ( �T� E4r{.Y �FI.��C,�.(rVll♦' TELEPHONE a (—)Qt a <br /> •' f G(,1 J <br /> PROPERTYADDRESS I <br /> LEGAL oExRlvnory bt7� 9 f o4e,g drier P 1,of C� <br /> MAILING ADDRESS e•�y L f <br /> � I <br /> TY11P����OF PERMITS): .5 I` <br /> �d:5ingle Family Dwelling ❑ Garage/Accessory Structure ❑ Stairs ❑ Commercial Buil ing [� <br /> El Addition Ll Bunkhouse EJFilling/Grading LI Commercial Addition j <br /> ❑ Deck U 59.692(ly)Gazeta ❑ Camping Unit ❑ Commercial Act. Structure 3 11 <br /> STRUCTURE/ADDTDON USE: <br /> F time/Cabin;Commercial Business Bedroom; Deck; etc) * n <br /> (fes'[' o I/ �,�r�I l,T/� / l ./� / C <br /> BUILDING CONTRACTOR: 1 `l 1`IJl `)V .Si I'V C� A <br /> J u <br /> PLOT PLAN ---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. _ <br /> ss*REOUIRED PLOT PLAN INFORMATIONT'* <br /> IL <br /> ❑ 8'/x"X 11"SHEET OF PAPER DISTANCE(IN FEET-1 TO: = t�—�- <br /> ❑ DRAWN TO SCALE OR DISTANCES LABELED ❑ WELL <br /> ❑ PROPOSED BUILDING/STRUCTURE LOCATION ❑ SEPTIC TANK& DRAINFIELD _ OJ <br /> ->Dimensions&Heights ❑ ROAD RIGHT-OF-WAY IF SURVEYED TD <br /> ❑ EXISTING BUILDINGS/STRUCTURES(Includes deck, porch, etc.) 4CENTERLINE IF NOT SURVEYED �- <br /> 4Dimensions&Heights ❑ ALL PROPERTY LINES — <br /> U NORTH ARROW ❑ ORDINARY HIGH WATER MARKin <br /> ❑ At &IETLANDy�A�RrEAS n UI <br /> NOTE: Building/structure location must be staked for onsite verification when needed. D II ,,I� M 6 <br /> ECEPJ E <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 1y1J, <br /> • Removal or cal lg of bees and vegetation is restricted along shoreline / <br /> • No structures(including retaining walls,etc.)are allowed unless specifically permitte OCT 3 2014 w , <br /> • No filling,grading,or shore land alterations are allowed unless spetfically pertained m <br /> • Driveway must meet width requirements within 60 clays of permit BURNETT COUNTY <br /> -1V <br /> • Accessory structure/garage Permits allow for private residential storage only TY <br /> •'Not to be used for human habitation or rental storage- <br /> ZONING n <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 <br /> this d upin by (including any accompanying schedule)and [further r to issue <br /> Matt recognize that this tall information y that tl will a <br /> result upon by Me County of Burnett Wisconsin in determining whether in issue a permit [further accept all liability that may be a <br /> result of the County of my or relying on other <br /> information I am ons to <br /> in this application. I e-att to permit ices a officials charged <br /> nable <br /> with faradministratinghpurpose <br /> county ordinances z or other auMorized persons M M1ave access M[M1e above-0esczibed premises at any reasonable <br /> time for the purpose of inspection. <br /> > ^ nnc > c <br /> --ADDITIONAL CONDITIONS--- <br /> G <br /> _ � T <br /> 3 <br /> OWNER'S SIGNATURE � � 3 ,-�.� <br /> (/ ate <br /> ZONING OFFICIAL ` O <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 sueams. '^ <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. <br />