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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 ice of Zoning Administrator c <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER A' 7e/ TELEPHONE <br /> PROPERTY ADDRESS J?�3� ]p J4du67 n/n h'k /dl _:5WSv <br /> LEGAL DESCRIPTION V <br /> f. <br /> 12- <br /> 27 1 <br /> MAILING ADDRESS <br /> TYPE OF PERMIT(S): <br /> U Single Family Dwelling U Garage/Accessory Structure ❑ Stairs ❑ Commercial Building <br /> ❑ Addition ❑ Bunkhouse U Filling/Grading ❑ Commercial Addition <br /> ❑ Deck ❑ 559.692(ly)Gazebo ❑/Camping Unit CICoQ1'mercial Act. Structure 9 <br /> STRUCTURE/ADDITION USE: AFi/Ja/L ( L'0H)171E�.L3/qL I I' z <br /> (Home/Cabin;Commercial Business; Bedroom; Dec ;etc.) <br /> BUILDING CONTRACTOR: <br /> r n <br /> PLOT PLAN ---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. _ <br /> ***REOUIRED PLOT PLAN INFORMATION*** <br /> ❑ 8'/a"X 11"SHEET OF PAPER DISTANCE (IN FEET)TO: o <br /> Cl DRAWN TO SCALE OR DISTANCES LABELED ❑ WELL <br /> ❑ PROPOSED BUILDING/STRUCTURE LOCATION ❑ SEPTIC TANK& DRAINFIELD <br /> -)Dimensions&Heights ❑ ROAD RIGHT-OF-WAY IF SURVEYED n- <br /> ❑ EXISTING BUILDINGS/STRUCTURES(Includes deck, porch, etc.) 4CENTERLINE IF NOT SURVEYED <br /> -)Dimensions&Heights ❑ ALL PROPERTY LINES o <br /> ❑ NORTH ARROW U ORDINARY HIGH WATER MARK <br /> ❑ ALL WETLAND AREAS <br /> NOTE: Building/stmcture location must be staked for onsite verification when needed. <br /> THIS PERMITIS 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 Fv <br /> • No filling,grading,or stare land alterations are allowed unless specifically permitted lr+�- <br /> • Dnveway must meet width requirements within 60 days of permit <br /> • Accessory structure/garage permits allow for private residential storage only z <br /> "Nat t0 be used for human habitation or rental storage" <br /> I declarei that ,corr application c (including an a um r M1a <br /> Op ( 9 Y accompanying schedule) s been examined by me and to Me beat of my knowledge and <br /> belief i[is true,correct and complete. anyingacknowledge that I am responsible for Me detail and accuracy of all Information provided <br /> wetl in <br /> this application byn he county any accompanying schedule)and r further aero is that I recognize that this information kaon y chat <br /> will be <br /> result upon by un County Burnett Burnett Wiscomin in ationiI am w villin in issue a permit r further accept all liability Ma[may be a <br /> with adf Me County comyorordirelynances <br /> or <br /> iher auhorionlamonsto have access to application. [agree topermit Premises <br /> anyrssoanged <br /> nable F <br /> with forthe Paning county o tion. ces or other authorized persons[o have access to IM1e above-aexribetl premises a[any reasonable <br /> time for the purpou of inspection. <br /> ter _ ^ nnc> o <br /> ---ADDITIONAL CONDITIIONS--- / I x w P 3 2 3 <br /> /rluSf'MGN II $e.�dg c,� /XL/N�N 7S Sfa N4LK �-W,.� -/rye. GE✓rtfM 11)le y l .� � p ^ - <br /> /$ 5-hzr�ce.Q 3o we. coA Venf� 5 Lark S. <br /> z ✓etch a/ of /l P r� sµace s Subw,j �wse�s, f✓ pnoi a 6 ji _ 8 <br /> O o✓1. Pa/h,A us- ' be- a/- /tors/- z42 <br /> ?-Do S? - o (n <br /> c . a �1��� z <br /> OWNER'S SIGNATURE cl o T. <br /> cn - v _ <br /> date _= F`3 x = =. m <br /> ZONING OFFICIAL / /y/ ZO ,� 3' _?, w <br /> (ante) h <br /> " 2 : a <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 on 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 Re <br /> mo <br /> rces <br /> wetlands identification web page or contact a Department of Natural Resources service center. N _ - <br />