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Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administrator NN 3 G <br /> APPLICATION FOR LAND USE PERMITSnn <br /> ON COMPUTE iEE <br /> OWNER HONE - <br /> �r:qd f�.'�a TELEP <br /> 7/r'' ?7J-3059 d <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION ,O/SSG SLEG•f[J W9/M TV A�fd• ��n <br /> MAILING ADDRESS X35' �7S'"j, .SOMU1'O, �t/< S%0o2S <br /> TYPE OF PERMIT(S): <br /> ❑ Single Family Dwelling Garage/Accessory Structure U Stairs ❑ Commercial Building <br /> ❑Addition ❑ Bunkhouse ❑ Filling/Grading ❑ Commercial Addition <br /> U Deck (❑J 559.6921 Gazebo LJ Camping <br /> /Unit I] Commercial Ace.Structure <br /> STRUCIUREADDITION USE:�J/g ,cj7tG/ ,� qIli <br /> v (Home/Cabin;CYom^mer'eal&sisiness;Bedroom; Deck;etc.) <br /> / z <br /> BUILDING CONTRACTOR: p_/,r/3',Z �/il/fa.�/f' <br /> r � <br /> PLOT PLAN ---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> ***REQUIRED PLOT PLAN INFORMATION*** <br /> U 8'/z"X 11"SHEET OF PAPER DISTANCE(IN FEET)T0: <br /> ❑ DRAWN TO SCALE OR DISTANCES LABELED U WELL Ft <br /> ❑ PROPOSED BUILDING/STRUCTURE LOCATION U SEPTIC TANK&DRAINFIELD I. <br /> 4Dimensions&Heights U ROAD RIGHT-OF-WAY IF SURVEYED <br /> U EXISTING BUILDINGS/STRUCTURES(Includes deck, porch, etc.) -)CENTERLINE IF NOT SURVEYED = L <br /> 4Dimensions&Heights U ALL PROPERTY LINES - <br /> U NORTH ARROW ❑ ORDINARY HIGH WATER MARK = ) <br /> ❑ ALL WETLAND AREAS, <br /> NOTE: Buildmicbstructure location most be staked for onsite veriFlcaum when needed. h(� I <br /> CZ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: i <br /> • Removal or cutting M bees and vegetation is restricted along shoreline <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 rt 2 <br /> '-'Not to be used for human habitation or rental storage'* e <br /> z <br /> I declare that this application(including any accompanying schaduls)has been examined by me and to the best of my knowledge and <br /> hand,it is trust correct and cordiale. I acknowledge that I am responsible for the detail antl accumq or all information widained in <br /> this application(including any accompanying schedule)and I Port <br /> Porter declare that I recognize that this information Providetl will be <br /> relied upon by the County of Burnett Wisconsin in determining whether be issue a second. I further amain 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 Perot 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 the purpose of inspection. <br /> r. 7 ➢ . O➢ O <br /> EJ <br /> --ADDITIONAL CONDMONS— F <br /> 3 � e <br /> S <br /> g `> M oA <br /> n <br /> Lao oar, <br /> OWNER'S SIGNATURE <br /> ZONING OFFICIAL 7 1 >a c^ <br /> (date) <br /> ­TOWN/UDC PERMITS MAYBE REQUIRED **THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCEfk <br /> c = <br /> You are responsible for complying with state and federal laws concerning construction near or on wetlands, lakes, and streams. - <br /> Wetlands that are hot 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 o o c o <br /> wetlands identification web page or contact a Department of Natural Resources service center. <br />