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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator a <br /> APPLICATION FOR LAND USE PERMITS y: <br /> N <br /> OWNER <br /> L),4L6 ROnN V& r2 610(456A0r0J Jv- TELEPHONE N <br /> 661 -4'815-89Ck <br /> PROPERTY ADDRESS 31!` 67 <br /> ` 7 1n6✓e QS 0#0 SA6g5Ui� -rbWNz N'I Y � <br /> LEGAL DESCRIPTION aa (40-15 <br /> P - O7-OILPg L- IN "TT5 2 ?3 bee i TwP4oRN(, (5 -a-5 cez / lI)J <br /> MAILING ADDRESS <br /> A05 I-W 2090 5, 802N5019.E.� /?1N , 5t30(0 0 <br /> TYPE OF PERMIT(S): ^ <br /> ❑ Single Family Dwelling Garage/Accessory Structure ❑ Stairs ❑ Commercial Building <br /> ❑ Addition ❑ Bunkhouse ❑ Filling/Grading ❑ Commercial Addition / <br /> ❑ Deck ❑ 59.692(ly)Gazebo ❑ Camping Unit <br /> Ll Commercial Acc. Structure <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) ° <br /> O <br /> BUILDING CONTRACTOR: LEP/IANi 574Li V(iS - 3,}5 iN.) Py,.DiZ - 6001VE,/VC: ?RyO J O <br /> l'7 <br /> � b <br /> PLOT PLAN --- INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> ***REQUIRED PLOT PLAN INFORMATION*** a <br /> 8'/2"X 11"SHEET OF PAPER DISTANCE(IN FEET)TO: o <br /> Cil'DRAWN TO SCALE OR DISTANCES LABELED WELL <br /> PROPOSED BUILDING/STRUCTURE LOCATION :,,,SEPTIC TANK&DRAINFIELD b <br /> 4Dimensions&Heights m' ROAD RIGHT-OF-WAY IF SURVEYED o 00 <br /> Ur EXISTING BUILDINGS/STRUCTURES(Includes deck, porch, etc.) --// 4CENTERLINE IF NOT SURVEYED <br /> 4Dimensions&Heights Gr ALL PROPERTY LINES o <br /> ❑ NORTH ARROW W ORDINARY HIGH WATER MARK 5. <br /> ❑ ALL AN Man <br /> y <br /> NOTE: Building/structure location must be staked for onsite verification when needed A3 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: MAR 2i 7 ZO15 <br /> • Removal or cutting of trees 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 BURN ETT COUNTY r" <br /> • Accessory structure/garage permits allow for private residential storage only ZONING <br /> **Not to be used for human habitation or rental storage** z <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge and <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 schedule)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 /> time for the purpose of inspection. <br /> A' 1sA 0000 � c � <br /> ---ADDITIONAL CONDITIONS--- 'V OJ J�f' "lr\ ���AAt0� c} �" o 9 El El o o g <br /> �. 3S' <br /> F . <br /> N G7 W N br9N rC�.y <br /> S > <br /> OWNER'S SIGNATURE <br /> ZONING OFFICIAL <br /> (date) rn C o m <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. 0° <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 F o U o <br /> wetlands identification web page or contact a Department of Natural Resources service center. ^ 0 0 0 0 0 <br />