Laserfiche WebLink
Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator 3 G <br /> A/PP/LICATION FOR LAND USE PERMITS <br /> L- = <br /> OWNER / I A /Y l TE�EPH7NE 7/G - O 6 <br /> PROPERTY ADDRESS <br /> r - c <br /> s <br /> LEGAL DESCRIPTION cl <br /> MAILING ADDRESS 757 f L^ / �� T) S �8✓�3 L= <br /> TYPE OF PERMIT(S): <br /> ❑ Single Family Dwelling '8 Garage/Accessory Structure ❑ Stairs ❑ Commercial Building R. <br /> ❑ Addidon Cl Bunkhouse ❑ Filling/Grading Cl Commercial Addition <br /> ❑ Deck ❑ 59.692(ly)Gazebo ❑ Camping Unit ❑Commercial Act. Structure <br /> STRUCR)RE/ADDMON USE: C• e ><-Kr. li.+ � �lol. nhKi%, f"s��on-oe <br /> (Home/Cabin;Commerdal Basi ess; Bedroom; k;etc.) <br /> A <br /> BUILDING CONTRACTOR: C `� <br /> PLOT PLAN ---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. A rn a <br /> k <br /> ***REQUIRED PLOT PLAN INFORMATION*** <br /> Cl 81h"X 11"SHEET OF PAPER DISTANCE(IN FEET)T0: o <br /> ❑ DRAWN TO SCALE OR DISTANCES LABELED ❑ WELL <br /> ❑ PROPOSED BUILDING/STRUCTURE LOCATION ❑ SEPTIC TANK&DRAINFIELD <br /> Dimensions&Heights ❑ ROAD RIGHT-OF-WAV IF SURVEYED t <br /> ❑ EXISTING BUILDINGS/STRUCTURES(Includes deck, porch,etc.) 4CENTERLINE IF NOT SURVEYED = l <br /> 4Dimensions&Heights ❑ ALL PROPERTY LINES - <br /> ❑ NORTH ARROW ❑ ORDINARY HIGH WATER MARK = <br /> ❑ ALL WETLAND AREAS _ L3 <br /> NOTE: Building/Structure location must he staked for onsite venfirabon when needed. F t <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> y CG <br /> • Removal or (including <br /> di trees and vegetation is restrictedalow along shoreline <br /> • No structures(including retaining walls,etc.)are allowed unless specifically emitted t� <br /> • No filling,grading,or snore land alterations are allowed unless specifically permitted <br /> • Driveway mus[meet width requirements within 60 days of permit r V1 X171 <br /> • Accessary structure/garage permits allow for private residential storage only F <br /> **Not to be used for human habitation or rental storage- <br /> is p <br /> I declare Nat this application(including any accompanying scbeduM)has been examined by me and to Me best of my knowledge and <br /> belief it is true,correct and complete. I acknowledge nut I am responsible for Me derail and accuracy of all information combined in <br /> this application(including any accompanying schedule)and I further declare that 1 recognize that this Information provided will be <br /> relied upon by Me county of Burnett Wisconsin in determining whether to leave a permit I further accept all liability that may be a <br /> result or Me county of Burnett relying on this information l am providing in this application. lagreetopermitcountyenicoucha,,w _ <br /> with administrating county ordinances or other authorized persons to have access to the allove4escribed premises at any reasonable <br /> time for the purpose of inspection. <br /> r » r. novC <br /> ---ADDITIONAL CONDITIONS--- F sn 3 = _ <br /> � = > <br /> C� _ <br /> ///� / °' n �s• in as <br /> OWNER'S SIGNATURE *at <br /> V' C (date)�/' <br /> ZONING OFFICIAL J - <br /> (date) <br /> --TOWN/UDC PERMITS MAYBE REQUIRED **THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE ' - 7 _ <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 associated with open water can be difficult to identify. Failure to Comply may result in removal or modification <br /> of construction that violates me 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. '" 8 _ _ = <br />