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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator 3 G <br /> APPLICATION FOR LAND USE PERMITS = <br /> I- A <br /> OWNER C.L.t AW TELEPHONE`'(03 6ga-�G� o <br /> �v1 Lt/V� J l��r✓j _ *`D <br /> PROPERTY ADDRESS <br /> t mr/�erU4 DFYM ICC <br /> LEGAL DESCRIPTION 7 � 0 <br /> � bl� S�n �a� <br /> MAILING ADDRESS <br /> rune 55313 <br /> TYPE OF PERMIT(S): <br /> Cl Single Family Dwelling XGarage/Accessory Structure U Stairs U Commercial Building _ <br /> O Addition O Bunkhouse U Filling/Grading U Commercial Addition j <br /> U Deck U 59.692(iv)Gazebo .U Camping Unit U Commercial Act. Structure <br /> � <br /> STRUCTURE/ADDITION USE: bUca f G>_P - �- <br /> (Home/rCabf 1;Commertlal Business, Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: ND/`1v�ce Q/cl,vTO- x <br /> T <br /> T_ n <br /> PLOT PLAN--- INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. S <br /> *REOUIRED PLOT PLAN INFORMATION*** m 4 <br /> 1 <br /> 81h"X 11"SHEET OF PAPER / DISTANCE(IN FEET)TO o <br /> DRAWN TO SCALE OR DISTANCES LABELED IY WELL 1 <br /> PROPOSED BUILDING/STRUCTURE LOCATION Wj SEPTIC TANK S.DRAINFIELD <br /> ibDimensions&Heights ROAD RIGHT-OF-WAY IF SURVEYED .� <br /> m EXISTING BUILDINGS/STRUCTURES(Includes deck, porch, Mc.) tbCENTERLINE IF NOT SURVEYED 1 <br /> L 7f Dimensions&HeightrOI ALL PROPERTY LINES o 1 <br /> W NORTH ARROW "ff-ORDINARY HIGH WATER MARK <br /> 4 ALL WETLAND AREAS c <br /> NOTE: Building/structure location must be staked for onsite verification when needed. 1 = <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> • Removal or cutting of trees and g walls,et is restricted along shoreline <br /> • No structures(intluding re l retaining walls,etc.)are allowedunlessspedoalky peritted <br /> • No filling,musing,or shore land alterationsrequirements <br /> within <br /> are allowed of per spepfically pennittetl <br /> • Driveway must meet width requirements within va days of permit <br /> • Acoes'-Not to a usedf r aragepuma permits allow for private storage-- <br /> I <br /> storage only <br /> **Not[o be used for human habitation or rental storage" <br /> I declare that this application(including any accompanying schedule)has been examined b v l� <br /> ( Y accuracy and N of best of mY knowledge and <br /> belie)it is trop mrrecl and nycomplete. <br /> accom I acknowledge eM1at I am responsible rot Ne detail and hatth s i all information contained in I11Y1 <br /> renapplication (including any accompanying n in dee)and [further declare that[recognize that this information provided will be <br /> relied upon by no County a aumett Wisconsin in determining whether in issue a permit. I(aunts accent all liability that may be a <br /> salt of the County of Burnett relying an this it suntanned <br /> I am onspraviding in this application. 1 agree ri permit countyofficials <br /> any re charged '< <br /> wine administrating county ordinances or other auNodzed persons to have access M Ne above4esmbed premises at any reasonable <br /> time for Ne puryose of inspection. <br /> nr > nr•. nn > � <br /> ---ADDITIONAL CONDITIONS--- m R 3 <br /> H 3 3 _ <br /> 3 Q a.a 3 a <br /> p - - __ ? m <br /> V i> �- : i <br /> pkv - ii <br /> - wnu4 to <br /> OWNER'S SIGNATURE <br /> n cr, cH m <br /> (date) <br /> ZONING OFFICIAL <br /> (date) �_ i £P v a <br /> **TOWN/UDC PER S MAY BE REQUIRED a*THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE -You are responsible for complying with state and federal laws conceming 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 /> of construction 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. o c <br />