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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator 3 l7- <br /> APPLICATION <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNERTELEPHONE n a <br /> �)rar,go <br /> PROPERTY ADDRESS 1 - Uj e r <br /> O <br /> �aCdonS P wtrWI�s i� 7 oa nd - <br /> LEGAL DESCRIPTION Z�� _C) rrof Lot5 1 j A 3 <br /> MAILING ADDRESS a. G (W o RR\VQ <br /> ��Y�'(�a) 7 � e3n = <br /> TYPE OF PERMITS): <br /> LI Single Family Dwelling LlGarage/Accessory Structure Cl Stairs Ll Commercial Building <br /> Addition El Bunkhouse ❑ Filling/Grading ❑ Commercial Addition <br /> Ll Deck ❑ 59.692(ly) Gazebo ❑ Camping Unit ❑ Commercial Act. Structure 3 1l6 '— <br /> 1 / c <br /> STRUCNRE/ADDITION USE: P C1 11 (� -F p f l \ 0 \}P <br /> IInn (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) C <br /> BUILDING CONTRACTOR: p <br /> PLOT PLAN ---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. � 3 <br /> v <br /> U < _ <br /> ***REQUIRED PLOT PLAN INFORMATION*** � <br /> Cl 81/2"X 11"SHEEF OF PAPER DISTANCE TIN FEET)TO' v <br /> ❑ DRAWN TO SCALE OR DISTANCES LABELED ❑ WELL <br /> ❑ PROPOSED BUILDING/STRUCTURE LOCATION ❑ SEPTIC TANK& DRAINFIELD <br /> -)Dimensions&Heights ❑ ROAD RIGHT-OF-WAY IF SURVEYED u <br /> ❑ EXISTING BUILDINGS/STRUCTURES(Includes deck, porch, etc.) 4CENTERLINE IF NOT SURVEYED - <br /> ->Dimensions&Heights ❑ ALL PROPERTY LINES o rJ <br /> ❑ NORTH ARROW ❑ ORDINARY HIGH WATER MARK _ t <br /> Ll ALL WETLAND AREAS <br /> NOTE: Builtling/sWcture location mus[be staked for onsite verification when needed. <br /> VV <br /> THIS PERMIT IS SUBIECT TO ALL CONDITIONS LISTED BELOW: -i <br /> • Removal or cutting of trees and vegetation is along shoreline <br /> • No structures(including retainare allowing walls,etc.)are allowed unless specifically permitted <br /> • No filling,grading,or shore land alterations are allowed unless specifrally 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 rental storage'" n <br /> I declare that this application(including any accompanying schetlule)has been examined by me and to the best of my knowledge and' <br /> belief it is true,corn¢and complete. I acknowledge Nat I am responsible for Me detail and accuracy of all information containetl in <br /> this application (including any accompanying schedule)and I further declare that I recognize that this information provided will be <br /> relied upon by the County of Burnett Wisconsin indetermininginformation <br /> am whether to issue a permit. I further accept all liability fbet may be a <br /> resuwith administrating <br /> County of Buy ed ordinances <br /> on or <br /> iher authorized <br /> persons <br /> to have access t application. (agree to Permit county officials charged '< <br /> time far me purpose <br /> coonyordinancesor oberaueorize0 Dersanz[a have access to aceabe e-dSSi[ib sGs n <br /> time far ace purpex of inspection. aIIr�,\a\(\nT�/jy//{(��co-r�I <br /> Y LJ �l CEJ L: V a <br /> ---ADDITIONAL CONDITIONS— `�' `�' e 3 <br /> JUL - 7 2014 <br /> til vi <br /> BURNEIT COUNTY <br /> ZONING <br /> OWNER'S SIGNATURE ' <br /> �J dace) _ <br /> o s <br /> ZONING OFFICIAL %� mitt 7 7-/Z zc <br /> (date) - <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 /> Wedands that are not associated with open water tin be difficult to identify. Failure to comply may result in removal or modification <br /> of construction eat 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 Determinant of Natural Resources service center c o o c o <br />