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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 TELEPHONE I ` <br /> _ �.�GC N a /S— 56 -t0 to A ISO <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION _ <br /> MAILING ADDRESS <br /> zo:?U3o W. 2c600. �lu£JLP. (Pl2 fJ�NBu�".,�% - Iuzi <br /> nJ m <br /> TYPE OF PERMIT(S): r ` <br /> O Single Family Dwelling A Garage/Accessory Structure 0 Stairs O Commercial Building e <br /> 11 Addition 0 Bunkhouse 'J Filling/Grading ❑ Commercial Addition <br /> •J Deck IJ✓519.692(ly) Gazebo ❑ Camping Unit ❑ Commercial Ace. Structure <br /> STRUCTURE/ADDITION USE: P/r VILG/UN Of ESV SIZUt� <br /> / (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) C _ <br /> BUILDING CONTRACTOR:T__JV= v(LD fRS <br /> PLOT PLAN --- INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. � <br /> s*'REQUIRED PLOT PLAN INFORMATION`*' a, G �q <br /> D R'/z•'X 11"SHEET OF PAPER <br /> DI—STANCE(IN FEET)TO I" <br /> 0 DRAWN TO SCALE OR DISTANCES LABELED 0 WELL <br /> ❑ PROPOSED BUILDING/STRUCTURE LOCATION 0 SEPTIC TANK&DRAINFIELD <br /> Dimensions&Heights J ROAD RIGHT-OF-WAY IF SURVEYED °c <br /> EXISTING BUILDINGS/STRUCTURES(Includes deck, porch, etc.) CENTERLINE IF NOT SURVEYED <br /> ODimensions&HeightsO ALL PROPERTY LINES o 1 <br /> 0 NORTH ARROW 0 ORDINARY HIGH WATER MARK — <br /> 0 ALL WETLAND AREAS <br /> NOTE: Building/structure location must he staked for onsite_verification when needed. s 6 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: � I <br /> • Removal or cutting of trees and vegetation is restricted along shoreline <br /> • No Rmctures(including retaining walls, etc.)are allowed unless specifically permitted (' <br /> • No filling,grading, or shore land alterations are allowed unless specifically permitted 'll3J <br /> • Driveway must meet width requirements within 60 days of permit — <br /> • Accessory structure/garage permits allmv for private residential storage only <br /> -Not to be used for human habitation or rental storage•` _ z Q <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 truq correct and Complete. I acknowledge that I am responsible for the detail and accuracy of all information contained in Iv I <br /> this application (including any accompanying schedule) and i further declare that I recognize that this information provided will be <br /> ried upon by the County of Burnett Wisconsin in determining whAt a,to issue a permit. I further accept all liability that may be a <br /> result of county of Burnett relying on this information l am providing in this aPinication. l agree to Permit county officials Charged Q <br /> tiwithmting county ordinances rdinaces or other authorized persons to hose access to the above-described premises at any reasonable <br /> e for the Purpose of inspection. <br /> bn <br /> --ADDITIONAL CONDITIONS--- a _ _ E 3 <br /> Sy'�uoru2E .vsr n GONFG7GT SYN S//S 393 i2fillTS FMS c `– > _ <br /> /a/G �3GdLa/.✓u S'EZ✓E7Z. �rccpa✓.T�E T ?�V` =N - e - <br /> aaS <br /> OWNER'S SIGNATURE ✓ fJ�( �( �L, _ L <br /> r _ <br /> ZONING OFFICIAL (date) <br /> v—(date) 45 - <br /> "TOWN/UDC PERMITS MAYBE REQUIRED 'THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE c constructionthat <br /> construction near or on wetlands, lakes, and streams. <br /> _— <br /> You are responsible for complying with state and federal laws concern <br /> Wedemis that are not associated with open water can be difficult to identify. Failure to comply may resin:in removal or modification <br /> ofconstruction that violates the law other penalties cr mats. For more information visit the Department of Natural Resources — <br /> ,wetlands Identification web page or contrh act a Department of Natural Resources service center. <br />