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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS = — <br /> OWNER //[� TELEPHONF� a' a <br /> A <br /> PROPERTYAD6RESs <br /> ( F <br /> LEGAL DESCRIPTION <br /> MAILING ADDRESS <br /> l77 L- aradr. /4v,- S �� Iva, 5:TZ — <br /> TYPE OF PERM3T(5): <br /> ❑ Single Family Dwelling jP Garage/Accessory Structure ❑ Stairs ❑ Commercial Building 3 <br /> ❑ Addition Cl Bunkhouse ❑ Filling/Grading ❑ Commercial Addition <br /> ❑ Deck Cl 59.692(ly)Gazebo ❑ Camping Unit U Commercial Ace. Structure <br /> r STRUCTURE/ADDITION USE: 6a r`ioyP <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) <br /> z rQ <br /> BUILDING CONTRACTOR: ell- �� C / s [9 ✓I � <br /> n <br /> PLOT PLAN ---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. e < u <br /> ***REOUIRED PLOT PLAN INFORMATION*** m c� <br /> ❑ 81/2"X 11"SHEET OF PAPER DISTANCE(IN FEET)TO: <br /> ❑ DRAWN TO SCALE OR DISTANCES LABELED ❑ WELL ) <br /> ❑ PROPOSED BUILDING/STRUCTURE LOCATION ❑ SEPTIC TANK&DRAINFIELD l <br /> -)Dimensions&Heights ❑ ROAD RIGHT-OF-WAY IF SURVEYED <br /> U EXISTING BUILDINGS/STRUCTURES(Includes deck, porch, etc.) 4CENTERLINE IF NOT SURVEYED v <br /> 4Dimensions&Heights U ALL PROPERTY LINES o. I <br /> ❑ NORTH ARROW ❑ ORDINARY HIGH WATER MARK <br /> ❑ ALL WETLAND AREAS y <br /> NOTE: Building/structure location must be slaked for onsite verification when needed. F r) <br /> THIS PERMIT 15 SUBJECT TO ALL CONDITIONS LISTED BELOW: - <br /> • Removal or cutting of trees and vegetation is restric[etl along shoreline F <br /> • No structures(including retaining walls,etc.)are allowed unless specifically permitt 1pW`\I <br /> • No filling,grading,or share land alterations are allowed unless specifically permitte SEP 5 2014 .5 <br /> • Driveway must meet width requirements within 60 days of permit s <br /> • Accessory structure/garage permits allow for private residential storage only COUNTY4 z <br /> *"Not to be used for human habitation or rental storage** BURNETT <br /> a <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the est of my knowledge and <br /> belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of all information conGineO in <br /> this application(including any accompanying schedule)and I further declare that I recognize Nat this information provided will be <br /> tallest 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 /> time for Me purpose of inspection. <br /> n '1900r➢ G > C� <br /> 3 <br /> ---ADDITIONAL CONDITIONS-- <br /> x co � � 3 3 0 = <br /> yv_a o: <br /> e 3 on <br /> on <br /> OWNER'S SIGNATURE <br /> don /!s t/) <br /> ZONING OFFICIALy/�.wi n+-.-� T// C74/ °' - <br /> C <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 contraction 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 NaWral Resources ,,, _ o <br /> wetlands identification web page or contact a Department of Natural Resources service center. ` <br />