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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator � C <br /> APPLICATION FOR LAND USE PERMITS - <br /> G= <br /> OWNER <br /> TELEPHONE <br /> N >9SZ'�9S-�Y>N U'1 <br /> A �abw hs- (r$Z— >vsz <br /> PROPERTY ADDRESS og C 1 <br /> 1e11�(1 � IV (�� <br /> LEGAL DESCRIPTIONi N <br /> �pT �ari nS Ri'Ve4- RhI", <br /> MAILING ADDRESS b. h _�- Lo-- BUMS <br /> 1 n./ BUMS /� IIS*01 I V I <br /> TYPE OF PERMI'l * �( V <br /> III Single Family Dwelling Garage/Accessory Structure ❑ Stairs 11 Commercial Building =_ <br /> ❑ Addition ❑ Bunkhouse ❑ Filling/Grading ❑ Commercial Addition ' <br /> ❑ Deck ❑ 59.692(ly)Gazebo ❑ Camping Unit ❑ Commercial Acc. Structure 9 <br /> STRUCTURE/ADDITION USE: m P I= Z <br /> Name/Cabin;Commercial Business; B tlroom; Deck;etc.) <br /> z <br /> BUILDING CONTRACTOR: SI 7EfP n, _ ffm Ai <br /> >_: r: <br /> rr <br /> PLOT PLAN ---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. c 3 _ <br /> ***REQUIRED PLOT PLAN INFORMATION*** � - <br /> ❑ 8I/2"X 11"SHEET OF PAPER DISTANCE(IN FEET)TO: o <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 1 , <br /> ❑ EXISTING BUILDINGS/STRUCTURES(Includes deck, porch, etc.) 4CENTERLINE IF NOT SURVEYED '- p <br /> Dimensions&Heights ❑ ALL PROPERTY LINES o _ <br /> ❑ NORTH ARROW ❑ ORDINARY HIGH WATER MARK �. <br /> ❑ ALL WETLAND AREAS y ' ) <br /> NOTE: Building/structure location must be staked for onsite verification when needed. I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> • Removal or cutting of trees and vegetation is restricted along shoreline A/J <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 - I <br /> • Driveway must meet width requirements within 60 days of permit <br /> • Accessary structure/garage permits allow for private residential storage only <br /> **Not to be used for human habitation or rental storage— <br /> _ <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge and G <br /> belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of all information contained in <br /> this application by <br /> (including any accompanying schedule)and 1 further declare e a 1 recognize that this information y that <br /> will be <br /> result upon by Me County of Burnett Wisconsin in determining whether to issue a permit. I further aper[all liability cia may chargedls e a <br /> with administrating <br /> tating ofmy Burned relying on this information l am providing access <br /> torthion. I ogres ulged premises <br /> at any reasonable f <br /> with farthe purpose <br /> county otion. ices or either authorized persons to have apess M[M1e above-tlescribetl premises at any reasonable <br /> time for Me purpose¢f inspection. <br /> n ,T, cs <br /> ---ADDITIONAL CONDITIONS--- 87 v+ n 9 = - - <br /> r � <br /> c <br /> 11 // llI m � oc _ ❑ <br /> OWNER'S SIGNATURE 7 Z'J ! o> <br /> fid .� <br /> _ = cno _ c <br /> ZONING OFFICIAL - m <br /> or <br /> dace) _ - <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 /> 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 - _ ct <br /> - <br /> wetlands Identification web page or contact a Department of Natural Resources service center. <br />