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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator 7 C• <br /> APPLICATION FOR LAND USE PERMITS - <br /> =_ A <br /> TELEPHONE <br /> PROPERTY ADDRESS - <br /> zzS�F nl L� o �� /.0 6Y✓Yo IS <br /> LEGAL DESCRIPTION V / / " Gj "Sec �� Tj QN R I.Q Li <br /> V 1 -1 CO <br /> MAILING ADDRESS Zz /Z 6eZ. <br /> TYPE OF PERMIT(S): <br /> ❑ Single Family Dwelling ❑ Garage/Accessory Structure ❑ Stairs ❑Commercial Building `? <br /> D Addition ❑ Bunkhouse D Filling/Grading ❑ Commercial Addition .a <br /> Deck ❑ 559,692(ly)Gazebo ,{ ❑ Camping Unit ❑ Commercial Acc. Structure 3 <br /> STRUCTURE/ADDF ION USE: <br /> (Home/Gbin;Commerdal Business; Bedroom; Deck;etc.) <br /> BUILDING CONTRACTOR: <br /> r v <br /> PLOT PLAN ---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> ***REQUIRED PLOT PLAN INFORMATION*** I� <br /> Cl 81h"X 11"SHEET OF PAPER DISTANCE (IN FEET)T0: . <br /> ❑ DRAWN TO SCALE OR DISTANCES LABELED ❑ WELL f� <br /> D PROPOSED BUILDING/STRUCTURE LOCATION D SEPTIC TANK& DRAINFIELD '_ I <br /> 4Dimensions& Heights ❑ ROAD RIGHT-OF-WAY IF SURVEYED <br /> D EXISTING BUILDINGS/STRUCTURES(Includes deck, porch, etc.) 4CENTERLINE IF NOT SURVEYED - cc <br /> -)Dimensions& Heights ❑ ALL PROPERTY LINES o 1 <br /> ❑ NORTH ARROW ❑ ORDINARY HIGH WATER MARK <br /> D ALL WELLAND AREAS <br /> NOTE: Building/structure location must be staked for onsite verification when needed. -z)Q-z�.. s <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: I')v I' <br /> • Removal or c Harg of trees and vegetation is restricted along shoreline I— 1 <br /> • No structures(inducing retaining walls,etc.)are allowed unless specifically permitted ICW`"I T <br /> • No filling,grading,or share land alterations are allowed unless spedfcally permitted Iz <br /> • Driveway must meet width requirements within 60 days of permit x <br /> • Accessory structure/garage pennits allow for private residential storage only <br /> •"Not to be used for human habitation or rental storage'" rT f? <br /> I declare Mat 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 Mat I am responsible for Me detail and accuracy of all information contained in <br /> this application(including any accompanying schedule)and I further declare that I recognize that this information provided will be <br /> relied upon by We County of Burnett Wisconsin in determining whether M issue a Permit I further accept all liability Mat may he a = [� <br /> result of Me county of Burnett relying on this Information l am Providing in this application. l agree to permitcounty officials charged IV <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 /> --ADDITIONAL CONDITIONS--- <br /> = > > c <br /> O <br /> �Y V ag ' $< $ oi <br /> di = € o3a _ <br /> OWNER'S SIGNATURE - <br /> (data) ' _ _ = d P <br /> ZONING OFFICIAL <br /> (date) <br /> -TOWN/UDC PERM AY BE REQUIRED "THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <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 assodated 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 cost. For more information visit the Department of Natural Resources - o <br /> wetlands iden8flcabon web page or contact a Department of Natural Resources service center. <br />