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r r <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator ? C <br /> APPLICATION FOR LAND USE PERMITS <br /> NER TELEPHONE <br /> .s 1 dNn <br /> r r r <br /> PROPERTY ADDRESS li <br /> (� <br /> goo sTIN 4k< Rff kX&;T6-ti'L LJ i ' W <br /> LEGAL DESCRIPTION <br /> �y nG Y>« )JIE VT5EC <br /> I I T'3q � I t ati�Flr�oJ TwS� c T <br /> MAILING A DRESS <br /> Yv )>eIJ6, —7j <br /> TYPE OF PERMIT(S): r <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 ❑ Commercial Acc. Structure 3 <br /> STRUCTURE/ADDITION USE: :5rogAGf-/54&-T-6 I z <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: �iJ r t. I I I F IMMf rZ C <br /> T I <br /> 7 U v <br /> PLOT PLAN ---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. 3 z <br /> t�•i — c d <br /> ***REQUIRED PLOT PLAN INFORMATION*** c �l <br /> 81/2."X 11"SHEET OF PAPER DISTANCE(IN FEET)TO: ° O <br /> DRAWN TO SCALE OR DISTANCES LABELED t>h ❑ WELL i QjQ <br /> PROPOSED BUILDING/STRUCTURE LOCATION fly ❑ SEPTIC TANK&DRAINFIELD <br /> -Dimensions&Heights jd ROAD RIGHT-OF-WAY IF SURVEYED (� <br /> NA EXISTING BUILDINGS/STRUCTURES (Includes deck,.porch, etc.) 4CENTERLINE IF NOT SURVEYED <br /> -Dimensions&Heights d ALL PROPERTY LINES c <br /> 0 NORTH ARROW 4 ORDINARY HIGH WATER MARK 5. 1 <br /> 'f ALL WETLAND AREAS <br /> NOTE: Building/structure location must be staked for onsite verification when needed. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <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 /> • Drtveway must meet width requirements within 60 days of permit . <br /> • Accessory structure/garage permits allow for private res dentia;storagr:only <br /> **Not to be used for human habitation or rental storage — Z <br /> ** <br /> N <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 f <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 � Bo � a <br /> --ADDITIONAL CONDITIONS— MEN <br /> v \ ` C <br /> G =L m a <br /> 1V074 � de u5eal {vr liUMOO �Qd,7L7�ieiJ . MAR 6 2015 m =! <br /> BURNETT COUNTY � <br /> W N W <br /> ZO N� <br /> OWNER'S SIGNATU - ) I I-S s <br /> date E n = r <br /> /z <br /> ZONING OFFICIAL - -- 3 20/5� <br /> (d te) = K E �� <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 , d <br /> of construction that violates the law or other penalties or costs. For more information visit the Department of Natural Resources N N 0 0 <br /> wetlands identification web page or contact a Department of Natural Resources service center. <br />