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C4 b r <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator b <br /> APPLICATION FOR LAND USE PERMITS N: <br /> O ^ <br /> = C <br /> OWNER TELEPHONE <br /> La_nc 4- S��-, i�e.���l�y L� 95�- $N3 - 33E1 <br /> PROPERTY ADDRESS al cl 7s.1 1 / ten SEafaIC+� !a Icy /- S L� lilt 7 v <br /> 6 l = <br /> LEGAL DESCRIPTION L O u / S`��i 0.k` `� J S / <br /> Y !� Nc c'k <br /> MAILING ADDRESS <br /> TYPE OF PERMIT(S): <br /> ❑ Single Family Dwelling ❑ Garage/Accessory Structure ❑ Stairs ❑Commercial Building = <br /> ❑ Addition ❑ Bunkhouse ❑ Filling/Grading ❑ Commercial Addition <br /> ❑ Deck ❑ 59.692(ly)Gazebo X camping Unit ❑ Commercial Acc. Structure <br /> STRUCTUREjADDITION USE: (n I I tl cRo'. z <br /> (Home/ bin;Commercial Business; Bedroom;Deck;etc.) <br /> O <br /> A <br /> BUILDING CONTRACTOR: O <br /> 7 � � <br /> PLOT PLAN ---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. o <br /> ***REQUIRED PLOT PLAN INFORMATION*** a <br /> ❑ 81/1"X 11"SHEET OF PAPER DISTANCE(IN FEET)TO: 0 1 <br /> ❑ DRAWN TO SCALE OR DISTANCES LABELED ❑ WELL <br /> ❑ PROPOSED BUILDING/STRUCTURE LOCATION ❑ SEPTIC TANK&DRAINFIELD <br /> -Dimensions&Heights ❑ ROAD RIGHT-OF-WAY IF SURVEYED c <br /> ❑ EXISTING BUILDINGS/STRUCTURES(Includes deck, porch, etc.) 4CENTERLINE IF NOT SURVEYED <br /> -Dimensions&Heights ❑ ALL PROPERTY LINES d <br /> N <br /> ❑ NORTH ARROW ❑ ORDINARY HIGH WATER MARK �. <br /> o N r s -e__ ❑ ALL WETLAND AREAS <br /> NOTE: Building/structure location must be staked for onsite verification when needed. D <br /> SCOW 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> * Removal or cutting of trees and vegetation is restricted along shoreline Q� <br /> • No structures(including retaining walls,etc.)are allowed unless specifically pei it MAR 3 0 2015 `( <br /> No filling,grading,or shore land alterations are allowed unless specifically per i e <br /> • Driveway must meet width requirements within 60 days of permit r- <br /> 1 <br /> • <br /> Accessory structure/garage permits allow for private residential storage only z d <br /> **Not to be used for human habitation or rental storage** BURNETT COUNTY n <br /> I declare that this application(including any accompanying that <br /> schedule)has been examined by a and to the best of at oomniknowledge and <br /> belief it is true,correct and complete. I acknowledge that I am responsible for the 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 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 /> r) o o N n <br /> A n <br /> ---ADDITIONAL CONDITIONS--- F vi 3 3 3 9,c . <br /> > W 6, <br /> < LI m Q < - <br /> �' g, " _ 7 <br /> OWNER'S SIGNATURE 3 <br /> II (date) _ nc 3 <br /> ZONING OFFICIAL 2 '"" '�' <br /> N = w : �n <br /> (date) a <br /> **TOWN/UDC PER MAY BE REQUIRED **THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE =o = 5 <br /> You are responsible for complying with state and federal laws concerning construction near or on wetlands, lakes, and streams. o w <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. S 0 0 0 <br />