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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 PERMITSIV <br /> N <br /> \ (^ <br /> OWNER �..� C s YhCI S <br /> INA V TELEPHONE i , <br /> PROPERTY ADDRESS o <br /> LEGAL DESCRIPTION3 <br /> �swt v Py m/ �� 3 <br /> MAILINGADDRESS <br /> TYP F PERMIT(S): r.Z� ]4j <br /> Single Family Dwelling ❑ Garage/Accessory Structure ❑ Stairs ❑ Commercial Building E. <br /> ❑ Addition ❑ Bunkhouse ❑ Filling/Grading ❑ Commercial Addition W <br /> ❑ Deck ❑ 59.692(Sv)Gazebo ❑ Camping Unit L3Commercial Acc. Structure <br /> // <br /> STRUCTURE/ADDITION USE: om eAw r////I <br /> z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) y ° <br /> BUILDING CONTRACTOR: /l/i� f'!1 �qNQ - /TO/✓l e— S 4/� p <br /> � n <br /> ,LOT PLAN ---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. < _ Z <br /> o_ <br /> ***REQUIRED PLOT PLAN INFORMATION*** <br /> ❑ 81/2"X 11"SHEET OF PAPER DISTANCE(IN FEET)TO: d <br /> ❑ DRAWN TO SCALE OR DISTANCES LABELED ❑ WELL N <br /> ❑ PROPOSED BUILDING/STRUCTURE LOCATION ❑ SEPTIC TANK&DRAINFIELD <br /> Dimensions&Heights ❑ ROAD RIGHT-OF-WAY IF SURVEYED c °o <br /> N <br /> ❑ EXISTING BUILDINGS/STRUCTURES(Includes deck, porch, etc.) CENTERLINE IF NOT SURVEYED <br /> 4Dimensions&Heights ❑ ALL PROPERTY LINES o <br /> ❑ NORTH ARROW ❑ ORDINARY HIGH WATER MARK 3. <br /> ❑ ALL WETLAND AREAS <br /> NOTE: Building/structure location must be staked for onsite verification when needed. <br /> o W <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: Il� 'Rs <br /> 1 <br /> • Removal or cutting of trees and vegetation is restricted along shoreline <br /> 1 <br /> • No structures(including retaining walls,etc.)are allowed unless specifically permitted p <br /> • No filling,grading,or shore land alterations are allowed unless specifically permitted �jLi ri 1 ^� Co. — W <br /> • Driveway must meet width requirements within 60 days of permit Tip <br /> • Accessory structure/garage permits allow for private residential storage only 7 <br /> **Not to be used for human habitation or rental storage** O <br /> a <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge and ti O <br /> belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all information contained in 0 <br /> this application (including any accompanying schedule)and I further declare that I recognize that this information provided will be d <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 /> n 0 0 0 a <br /> ---ADDITIONAL CONDITIONS--- 3 <br /> BLAOW4 y hof � e-?(Ca �%, �el9l.f �o =_. � smN: <br /> 3 aro e s aG. 71/9 33 <br /> vhp,- l�/y, to <br /> 10da : p03 <br /> C n W W N w <br /> OWNER'S SIGNAT RE <br /> (date _ <br /> ZONING OFFICIALT " ' v <br /> (d e) o_ <br /> C a <br /> **TOWN/UDC PER ITS MAYBE REQUIRED **THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE g <br /> You are responsible for complying with state and federal laws concerning construction near or on wetlands, lakes, and streams. L' <br /> o : <br /> Wetlands that are not associated with open water can be difficult to identity. Failure to comply may result in removal or modificat on d A <br /> of construction that violates the law or other penalties or costs. For more information visit the Department of Natural Resources J N o o <br /> wetlands identification web page or contact a Department of Natural Resources service center. ^ 0 0 0 0 0 <br />