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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator & 9 b <br /> APPLICATION FOR LAND USE PERMITS N: y <br /> lD <br /> OWNER- TELEPHONE. -22 <br /> c <br /> PROPERTY ADDRESS <br /> Ib LQ1liE z b J2 a,-r�2 o <br /> LEGAL DESCD-) —O 3 2- -L - K I— 1 f- 19—Jam—I•-- kl SIJ O 0 M <br /> o I M <br /> MAILING ADDRESSY12-7 QJ, L o `U <br /> TYPE OF PERMIT(S): w <br /> ❑ Single Family Dwelling ❑ Garage/Accessory Structure ❑ Stairs ❑ Commercial Building 2 <br /> ❑ Addition ❑ Bunkhouse Filling/Grading ❑ Commercial Addition <br /> ❑ Deck [ 59.692(ly)Gazebo ❑ Camping Unit ❑ Commercial Acc. Structure <br /> STRUCTURE/ADDITION USE: der z <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: ���/`rt Uu/✓�� O <br /> ro <br /> PLOT PLAN ---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. C < <br /> - c <br /> ****REQUIRED PLOT PLAN INFORMATION*** <br /> ad/ 8'/2"X 11"SHEET OF PAPER / DISTANCE (IN FEET)TO: d <br /> PJ DRAWN TO SCALE OR DISTANCES LABELED WELL <br /> PROPOSED BUILDING/STRUCTURE LOCATION @l SEPTIC TANK&DRAINFIELD o <br /> ao � <br /> 4Dimensions&Heights Er/ ROAD RIGHT-OF-WAY IF SURVEYED o <br /> I� EXISTING BUILDINGS/STRUCTURES(Includes deck, porch, etc.) 4CENTERLINE IF NOT SURVEYED 2' <br /> / 4Dimensions&Heights E ALL PROPERTY LINES o <br /> f3 NORTH ARROW M3 ORDINARY HIGH WATER MARK a. I <br /> ( Wr' ALL WETLAND AREAS <br /> NOTE: Building/structure location must be staked for onsite verification when needed. <br /> � I <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: tUI <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 I <br /> • Accessory structure/garage permits allow for private residential storage only JN Cj <br /> **Nat to be used for human habitation or rental storage** z <br /> d <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 uNF,I <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 �c <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. �� ���� r <br /> > 0 0 o N a � <br /> ---ADDITIONAL CONDITIONS--- x us g <br /> M O q <br /> 3 <br /> NOV 2 120*1'r <br /> ® anaa•• : <br /> BURN-EfT�T COUNTY <br /> NING 'w D <br /> ZO <br /> - � n in v,i»ypyw �' <br /> OWNER'S SIGNATURE 0. <br /> con <br /> (date) y El <br /> ZONING OFFICIAL !vf� <br /> N p <br /> date CM n <br /> ( ) o i C ; m m <br /> **TOWN/UDC PERMITS MAY BE REQUIRED **THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ' OQ�' <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 /> P fY• P Y Y <br /> of construction that violates the law or other penalties or costs. For more information visit the Department of Natural Resources N o o <br /> wetlands identification web page or contact a Department of Natural Resources service center. ^ ^ o 0 0 0 r) <br />