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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 /> OWNER /�Jt i�IARD _L 2/' ��AXI� CaDO� TELEP7iS' —CSG —yOOL^ � <br /> PROPERTY ADDRESS r D �^ <br /> LEGAL DESCRIPTION <br /> si HA2 t�u,o ' g I?lvr-,e Y�irv�' <br /> c <br /> MAILING ADDRESS )- <br /> TYPE in PERamily D ....l!�� <br /> ❑ Single Family Dwelling ,swarage/Accessory Structure Zi Stairs ❑ Commercial Building <br /> ❑Addition ❑ Bunkhouse ❑ Filling/Grading ❑ Commercial Addition 7C <br /> ❑ Deck ❑ 59.A692(ly)Gazebo ❑ Camping Unit ❑ Commercial Acc. Structure ° Y <br /> STRUCRIRE/ADDTTION USE: G�� �//l1' S I- <br /> Z <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) (J) <br /> BUILDING CONTRACTOR: <br /> 7 <br /> PLOT PLAN---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> ***REQUIRED PLOT PLAN INFORMATION*** <br /> ❑ 81/2"X 11"SHEET OF PAPER DISTANCE(IN FEET)TO p <br /> ❑ DRAWN TO SCALE OR DISTANCES LABELED '❑ WELL y" <br /> ❑ PROPOSED BUILDING/STRUCTURE LOCATION ❑ SEPTIC TANK&DRAINFIELD <br /> r6Dimensions&Heights ❑ ROAD RIGHT-OF-WAY IF SURVEYED N a <br /> ❑ EXISTING BUILDINGS/STRUCTURES(Includes deck, porch, etc.) l6CENTERLINE IF NOT SURVEYED - <br /> F Dimensions& Heights ❑ ALL PROPERTY LINES �. <br /> ❑ NORTH ARROW ❑ ORDINARY HIGH WATER MARK = <br /> ❑ ALL WETLAND AREAS J <br /> NOTE: Building/structure location must be staked for onsite verification when needed. <br /> THIS PERMIT IS SUBJECTTO ALL CONDITIONS LISTED BELOW: <br /> • Removal or cutting of trees and vegetation is resMcted along shoreline W U1 <br /> • No structures(including retaining walls,etc.)are allowed unless specifically permitted Z A pN <br /> • No filling,grading,or shore land alterations are allowed unless specifically permitted Cj p <br /> • Driveway must meet width requirements within 60 days of permit <br /> • Accessory structure/garage permits allow for private residenhal storage only <br /> **Not to be used for human habitation or rental storage'* z <br /> I declare Mat His application(including any accompanying schedule)has been examined by me and to the bear of my knowledge and fi IiLIIi_ /-� R <br /> belief it is true,correct and complete. I acknowledge Mat I am responsible for the detail and accuracy of all information contained in O <br /> this application(including any accompanying actedule)and I further declare Mat I recognize that this information provided will be V <br /> relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I further accept all liability Mat may be a <br /> result of the county of Burnett relying an 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 Me above-described premises at any reasonable <br /> time for the purpose of inspection. <br /> —ADDITIONAL CONDITIONS— F w 3 Fl 3 a <br /> � n > <br /> /'�q� <br /> OWNER'S SIGNATURE �� Q � w� ✓ � �C�� n �� � n � �, <br /> (date) _ R H 4 p <br /> ZONING OFFICIAL � - <br /> (date) _ ! x a <br /> '*TOWN/UDC P R S MAYBE REQUIRED **THIS PERMIT SHALL EMPIRE ONE YEAR FROM DATE OF ISSUANCE -You r 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 t0 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 0 o c o <br />