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tI� <br /> Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR LAND USE PERMITS <br /> r�(L <br /> OWNER �,, / / ' TELEPHONE I" <br /> �r- <br /> PROPERTY ADDRESS ZS (1�. <br /> OO �/M,�� R�_�O H/L Lfl_" is <br /> LEGAL DESCRIPTION <br /> �qta -S-L6 c w0/Mn7V�_j�/PmLgU+L�� <br /> MAILING ADDRESS ,43 5� 2S'`)f c .SO,aa��� Gt� .fS��e�s ✓✓ - - <br /> TYPE OF PERMIT(S): <br /> J Single Family Dwelling AGarage/Accessory Structure U Stairs J Commercial Building <br /> U Addition U Bunkhouse J Filling/Grading U Commercial Additions Ir,� <br /> U Deck U 59.692(ly)Gazebo J Camping Unit U Commercial ACc.Structure _ r IN^— <br /> STRUCTURE/ADDRION USE: p'T"' ff' ySb 4 <br /> lLf r71- <br /> (Home/Cabi�mercial Br7sirlest;Bedroom; Dad;etc.) e <br /> BUILDING CONTRACTOR: [qe b = w <br /> r � <br /> PLOT PLAN---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. — a <br /> ***REQUIRED PLOT PLAN INFORMATION*** a <br /> U 81h"X 11"SHEET OF PAPER DISTANCE(IN FEET)TO: <br /> U DRAWN TO SCALE OR DISTANCES LABELED U WELL = <br /> U PROPOSED BUILDING/STRUCTURE LOCATION U SEPTIC TANK&DRAINFIELD I� <br /> 4Dimensions&Heights U ROAD RIGHT-OF-WAY IF SURVEYED <br /> U EXISTING BUILDINGS/STRUCTURES(Includes deck, porch,eta.) 4CENTERLINE IF NOT SURVEYED <br /> 4Dimensions&Heights Cl ALL PROPERTY LINES <br /> ZI NORTH ARROW CI ORDINARY HIGH WATER MARK <br /> U ALL WETLAND AREAS_ In _ <br /> NOTE: Building/structure location must be staked for onsite venfica cs,when needed. ) <br /> THIS PERMIT IS SUB]ECTTO ALL CONDITIONS LISTED BELOW: <br /> • Removal or"me of trees and vegetation is restricted along shoreline U LIP,Y�G <br /> • No structures(including retaining walls,etc.)are alloyed unless specifically permitted t� <br /> • No filling,grading,or More land alterations are allowed unless sirearimlly permitted <br /> • Driveway must meet widM requirements within W days of permit <br /> • Accessory structore/garage Permits allow for private residential storage only .� <br /> "Not to be used for human habitation or rental storage" <br /> I declare but this application(including any arcanpanying schedule)has boon eaamlned by me and to the bract of my krrowholo and _ <br /> War,it Is trvy comet all Complete. I acknowledge that I am no,onsib4 for an,detall all accuracy of all infprmatlan raMshadi in <br /> this application(including any accompanying schedule)and I fuller declare MM I magmatic that this information provided will be <br /> relied upon by the County of ,moyin Wisconsin in atamI am wMther m issue a permit I further accept all alt county <br /> that may be a <br /> retuNoftheho tat dBumeRrelyi,gonthis other omwtion zed amamounting <br /> ave access <br /> to mion. IagrooNpenpromissatanyreasols mged - <br /> wiM adminlstraHne county ordl,urku or other authorized persons to have access to Ne above-Eacnbed premises of any reasonable <br /> Gone for Me Panama of norha.non. <br /> --ADDITIONAL CONDITIONS--- _ g 3 2 <br /> 31 l <br /> OWNER'S SIGNATURE <br /> ZONING OFFICIAL7- c _ "_ at <br /> l (date) _ <br /> **TOWN/UDC PERMITS MAY BE REQUIRED *'THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE -You are responsible for complying with state and federal laws concerning construction near or on wetlands, takes, and streams. <br /> wetlands that are not associated with open water can be difficult to idenbfy. Failure to comply may result in removal or modification <br /> of cmstruetibn that violates Ne law a other penaltes or costs. For more information visit the Department of Natural Resources — <br /> wetlands identification web page or contact a Department of Natural ReSWroes Service Ceni '^`N"8 0 0 <br />