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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 /> c A <br /> OWNER / TELEPH/--c—JONE <br /> 1�e(/o kJ �e Y110 ti' �e e � rll. - �� /�,%n G• (L"^' <br /> PROPER4 ADDRESS <br /> 2 4 1 s Y .1? <br /> LEGAL DESCRIPTION <br /> t s ) v_g �L 1_7 ° C? <br /> l <br /> MAILING ADDRESS - <br /> TYPE OF PERMIT(S): <br /> Cl Single Family Dwelling ,Garage/Accessory Structure ❑ Stairs U Commercial Building _ <br /> ❑ Addition O Bunkhouse Cl Filling/Grading Cl Commercial Addition .� <br /> ❑ Deck Cl 59.692(ly)Gazebo 11 II U C\amping Unit U Commercial Acc. Structure <br /> STRUCTURE/ADDITION USE: Cw.c- "1-4- - �T I - I _ _ 7K <br /> �I- --•— — -(name/Cabin;-Commercial Bus[ness,Becrbort%Deck;`el <br /> )G <br /> uTUDING CONTRACTOR:�V I P,tom•\U -'TL4.l LWL - y <br /> T gO' rR <br /> PLOT PLAN ---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. � a <br /> i <br /> ***REOUIRED PLOT PLAN INFORMATION*** m <br /> Cl 81h"X 11"SHEET OF PAPER DISTANCE(IN FEET)T0: Z( o <br /> U DRAWN TO SCALE OR DISTANCES LABELED Cl WELL <br /> ❑ PROPOSED BUILDING/STRUCTURE LOCATION U SEPTIC TANK&DRAINFIELD <br /> -)Dimensions&Heights ❑ ROAD RIGHT-OF-WAY IF SURVEYED ' <br /> r <br /> U EXISTING BUILDINGS/STRUCTURES(Includes deck, porch, etc.) iCENTERIINE IF NOT SURVEYED (1 <br /> Dimensions& Heights U ALL PROPERTY LINES <br /> Cl NORTH ARROW ❑ ORDINARY HIGH WATER MARK <br /> U ALL WETLAND AREAS Imo, 1t IIt� o <br /> NOTE: Building/stricture location mus[be staked for onsite verification when needed. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: (i''��(n pr1 (r(,. -i T <br /> • Removal or cutting of Gees and vegetation is restricted along shoreline EI;CE <br /> 11`J <br /> • No structures(including retaining walls,etc.)are allowed unless specifically permitte D 1115555 NJ Lam❑ <br /> • No filling,grading,or shore land alterations are allowed unless specifically permitted II(,V�A <br /> • Driveway must meet width requirements within 60 days of permit OCT 6 N14 ?w J <br /> • Accessory structure/garage permits allow for private residential storage only n <br /> Not to be used for human habitation or rental storage-' n z <br /> Rl <br />—1 declare that this application(including any accompanying schedule)has been examined by me,and to[heyelr,q p e ge and J <br /> belief it is true,correct and complete. I acknowledge that 1 am responsible for the detail and accuracy o on wnfained 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 adept all liability that may be a <br /> result of the County of Burnett relying on this information l am providing In this application. I agree to permit County ofridals 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 /> n1. > nnnn> <br /> ---ADDITIONALCONDITIONS--- <br /> 3L`� <br /> l`Ij1 Fn > <br /> d > !> N N <br /> � : S8z <br /> OWNER'S SIGNATURE'`/� "' ,ef—. Ib,Z—JN°/ n >� 0 0 0 <br /> ate xe x <br /> ZONING OFFICIAL �0 a eZ0/ <br /> **TOWN/UDC PERMITS MAYBE REQUIRED **THIS PERMIT SHALL EXPIRE ONENEAR FROM DATE OF ISSUANCE _You are responsible for complying with state and federal laws concerning construction near or on wetlands, lakes, and streams. , g <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 S o U 8 <br /> wetlands identifiaaan web page or Contact a Department of Natural Resources service center. v, � <br />