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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator 3 C <br /> APPLICATION FOR LAND USE PERMITS = <br /> I a <br /> OWNER 1 a �YlM tc�.f TELEPHONE <br /> PROPERTYADDRESSIv <br /> E- F 1�aU,s.wr.. IJ:S <br /> LEGAL DESCRIPTION <br /> S 14 r 'lo A) 12 l7 v7 65'^ L.t I ✓7 P. Nl n 1 <br /> MAILING ADDRESS <br /> M1 ( LvS �K'[S 30 <br /> TYPE OF PERMIT(S): r <br /> ❑ Single Family Dwelling AGaage/AccessoryStructure ❑ Stairs U Commercial Building I '; <br /> U Addition Cl Bunkhouse U Filling/Gading ❑ Commercial Addition <br /> U Deck ❑ 59.692(ly)Gazebo ❑ Camping Unit Cl Commercial Add. Structure 3 <br /> STRUCTUREJADDITION USE: 4 i�- ,,AK94E <br /> (Home/Cabin;Commercial BULness;Bedroom; Deck; etc.) = i <br /> BUILDING CONTRACTOR: <br /> +i W <br /> PLOT PLAN ---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. z <br /> ***REOUIRED PLOT PLAN INFORMATION*** ' 2 <br /> U IPA"X 11"SHEET OF PAPER DISTANCE(IN FEET)T0: <br /> ❑ DRAWN TO SCALE OR DISTANCES LABELED ❑ WELL <br /> U PROPOSED BUILDING/STRUCTURE LOCATION ❑ SEPTIC TANK& DRAINFIELD <br /> Dimensions& Heights Cl ROAD RIGHT-OF-WAV IF SURVEYED <br /> U EXISTING BUILDINGS/STRUCTURES(Includes deck, porch, etc.) -)CENTERLINE IF NOT SURVEYED <br /> -)Dimensions&Heights ❑ ALL PROPERTY LINES — <br /> ❑ NORTH ARROW ❑ ORDINARY HIGH WATER MARK l <br /> ❑ ALL WETLAND AREAS r1 <br /> NOTE: Building/structure location must be sGketl for onsite verification when needed. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 1 <br /> • Removal or cutting of trees and vegetation is restricted along shoreline l <br /> • No structures(including retaining walls,etc.)are allowed unless specifically permitted (— <br /> • No filling,grading,or shore land alterations are allowed unless specifically 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 he used for human habitation or rental storage" <br /> Ia d <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the beat of my knowledge and Q <br /> belief it is true,Correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information contained in `J <br /> this application(including any accompanying schedule)and I Turner 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 no County of Burnett relying on lois information l am providing in this application. I agree to Permit countyofnciais QQ rged - £ <br /> with administrating county ordinances or other authorized persons to have access to the]bdye d,—d'amd7p m esaran sdnable <br /> time for one purpose of inspection. }_ _ L, V <br /> — <br /> ADDITIONALCONDITIONS-- fUi Fly;E. 5 3 _ <br /> JUN 1 7 2014 <br /> BURNETT COUNTY z _ <br /> ZONING <br /> 1yA ' - - ^ <br /> OWNER'S SIGNATURE/7y/.MI'/✓ /I r Ifr�r (o -�g 1 `I ' <br /> ZONING OFFICIAL �� i <br /> -C�G/ �j_/& �j <br /> (date) A C C <br /> ''TOWN/UDC PERMITS MAY BE 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 wetlantls, lakes, and streams 4 <br /> Wif <br /> etlands that are not associated with open water Can be diffimlt to identify. Failure to Comply may result m removal a modification <br /> of construction that violates the law or other penalties or costs. For more information visit Ne Department of Natural Resources _ <br /> wetlands identification web page or contact a Department of Natural Resources service center. — <br />