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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> /' W <br /> APPLICATION FOR LAND USE PEERMITS <br /> OWNERhQ-( ICS a,LA vhv C, K) TEL L6,,.f. <br /> C �k-7/S- IO <br /> PROPi CCC R R"h•.+#'-sly-ssF/;67 <br /> I s <br /> LEGAL DESCRIPRON _T_ nl IZLU) I S <br /> MAI}}��NRE55 <br /> G AppD �1 <br /> dSS/ g ; 0 <br /> OFPE - 1 <br /> TYPE OF PERMITS): <br /> ;9 Single Family Dwelling ❑ Garage/Accessory Structure ❑ Stairs ❑ Commercial Building <br /> ❑ Addition ❑ Bunkhouse ❑ Filling/Grading ❑ Commercial Addition <br /> ❑ Deck nn❑ 59.692(ly)Gazebo ❑ Camping Unit ❑ Commercial Add. Structure <br /> SIRUCTURE/ADDITION USE: /�"r�v4/! Q///�(,G{yrls.� Q f�J��j� p/I <br /> L <br /> (Home/ bin; Commercial Business Bedroom; Deck;etc.) <br /> p <br /> BUILDING CONTRACTOR: r j, <br /> N <br /> PLOT PLAN --- INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. " S z <br /> ***REOUIRED PLOT PLAN INFORMATION*** <br /> ❑ 81A"X 11"SHEET OF PAPER DISTANCE(IN FEET)TO o <br /> L) DRAWN TO SCALE OR DISTANCES LABELED LI WELL <br /> ❑ PROPOSED BUILDING/STRUCTURE LOCATION ❑ SEPTIC TANK&DRAINFIELD V <br /> ->Dimensions&Heights ❑ ROAD RIGHT-OF-WAY IF SURVEYED v <br /> ❑ EXISTING BUILDINGS/STRUCTURES (Includes deck, porch, etc.) 4CENTERL[NE IF NOT SURVEYED - I <br /> Dimensions&Heights ❑ ALL PROPERTY LINES o <br /> ❑ NORTH ARROW ❑ ORDINARY HIGH WATER MARK - <br /> Cl ALL WETLAND AREAS n <br /> NOTE Building/stnc[ure 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 /> • Driveway must meet wicth requirements within 60 days of permit <br /> • Accessory structure/garage permits allow for private residential storage only C� <br /> **Not to be used for human habitation or rental storage** <br /> I declare that this application <br /> (including any accompanying schedule)nsi been the detail by a and to of best of my knowledge a antl <br /> belief it is[rue,correct and complete. I acknowledge Nat I am responsible far[M1e detail and accuracy of all information contained in <br /> Nis applicationoby <br /> he(including any accompanying n in Bele)and I further r to issue <br /> that I recognize that this information y that tl will a <br /> ref d upon by Ne County at Burnett Wisconsin in determining whether in issue a permit. I further accept all liability that may charged e a <br /> suit of Ne caunty ting ofunty or ina nce o rl cher uthorion l am proons to have access t i he al I agree to permit isesat an y re cmbed £ <br /> with for administrating county ordinances or other authorized persons[o have access ce Me above-Oettribetl premises at any reasonable <br /> time for the purpose of inspection. <br /> rr '•1 > onnct > � <br /> —ADDITIONAL CONDITIONS--- R rr <br /> —//7 r4&r sTF/v /.✓r7yju �� F'�?rT �i /7.�0 � 3 G e <br /> �/77D.rif�L Gu/Dc2��✓FS' > m <br /> Jo _ un n <br /> � a <br /> OWNER'S SIGNATURE <br /> (earel o r. is <br /> ZONING OFFICIAL N��� g Y,�� - - xa = ¢ ✓' <br /> dace) <br /> A C <br /> --TOWN/UDC PERMITS MAYBE REQUIRED THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCEYou - - <br /> Wet are responsible for complying with state and anbefederal laws concerning construction near or y r wetlands, lakes, and streams.of <br /> construction <br /> that are not associated with open water can be difficult to r more Failure to comply may result in removal or modification <br /> of construRion that violates the law or other penalties or costs. For more information visit the Department of Natural Resources - <br /> wetlands identification web page or contact a Department of Natural Resources service center. <br />