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- r <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> (, APPLICATION FOR LAND USE PERMITS <br /> OWNER TELEPHONE - � <br /> PROPERTY ADDRESS <br /> Lor / ;^< ! f /. rz f cYn 1/ /O - S ; E. i.•i H ?. <br /> LEGAL DESCRIPTION .S26 a/b <br /> MAILING ADDRESS <br /> TYPE OF PERMIT(S): <br /> (pSingle Family Dwelling Garage/Accessory Structure U Stairs U Commercial Building <br /> U Addition U Bunkhouse U Filling/Grading U Commercial Addition <br /> ^S <br /> U Deck U 59.692(ly)Gazebo U Camping Unit U Commercial Acc. Structure a <br /> MUCNRE/ADDIITON USE: CN QIP J !J - <br /> u (Home/C in; Commercial Business; Betlroom; Deck;e[cJ 0 J <br /> BUILDING CONTRACTOR:_{/l i✓s lidgj�ld a�:1 r/.;� J Lel/ ��.i .m.� y11 O I� J <br /> m <br /> PLOT PLAN ---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. _ R' <br /> ***REQUIRED PLOT PLAN INFORMATION*** <br /> X B'/z"X 11'SHEET OF PAPER DISTANCE(IN FEET)TO: <br /> af DRAWN TO SCALE OR DISTANCES LABELED 12 WELL r <br /> I#- PROPOSED BUILDING/STRUCTURE LOCATION a SEPTIC TANK&DRAINFIELD <br /> 4Dimensions&Heights A ROAD RIGHT-OF-WAY IF SURVEYED lll___rrr���PPP <br /> ,4 EXISTING BUILDINGS/STRUCTURES(Includes deck, porch, etc.) -3CENTERLINE IF NOT SURVEYED T <br /> 4Dimensions&Heights HYG Z,c 117 f,1",,ye.1 M ALL PROPERTY LINES _o <br /> ❑' NORTH ARROW Yd ORDINARY HIGH WATER MARK = <br /> 157 ALL WETLAND AREAS If h c r <br /> NOTE: Building/structure location must be staked for onsite verification when needed. ECM('r��D <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ) y l 1 <br /> • Removal or cutting of trees and vegetation is restricted along shoreline <br /> • No structures(including retaining walls,etc.)are allowed unless specifically per - - <br /> • No filling,grading,or shore land alterations are allowed unless specifically perm; SEP 3 0 2014 <br /> • Driveway must meet width requirements within 60 days of permit <br /> • Accessory structure/garage permits allow for private residential storage only 1- <br /> BURNM COUNTY <br /> **Not to be used for human habitation or rental storage'* <br /> I declare that this application(including any accompanying schetlule)has been examined by me antl[ my knawletlge antl T r <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 application (including any accompanying achedule)and I further declare that I recognize that this information provided will be <br /> relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I further accept all liability that may be a <br /> result of the County of Burnett relying 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 above-described premises at any reasonable <br /> Co7UTZNUED oNJ DK PFS —)T n c <br /> ADD1T[ONAL CONDITIS <br /> Nr�trr Pr16tE. <br /> ONo P!1'rsos�s7st-ze ,°�TAzivsnc, wst�cs, Erc i9G�owED t�sr/rsN 6r <br /> �� 95 s67BAcR! <br /> / <br /> ^ JJS 7086 M0�6D To MEET THE �/O SETBACK To TH6 - a ? = v = a <br /> pKIV14TE RD�DRzvEwAY. <br /> cF <br /> OWNER'S SIGNATUR`E/�/ r <br /> ZONING OFFICIAL _/ m- rF m <br /> = C <br /> — <br /> ­TOWN/UDC PERMITS MAYBE REQUIRED ­THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ' _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 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 II� <br /> wetlands identification web page or contact a Department of Natural Resources service center. <br />