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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator C <br /> APPLICATI/O�N FOR LAND USE PERMITS M <br /> OWNER .7'J�����(/ � /Ii/I�✓/ /9✓��E1lf !/. LEPHONE <br /> PROPERTY ADDRESS <br /> LEGAL DESCRIPTION <br /> Lot G Csi✓1 VJ�fi�'��G.S �yf'33Y7L�SE Sul N <br /> MAILING ADDRESS <br /> TYPE OF PERMITS): 7 <br /> Cl Single Family Dwelling Garage/Accessory Structure ❑ Stairs ❑Commercial Building <br /> ❑ Addition ❑ Bunkhouse ❑ Filling/Grading ❑ Commercial Addition <br /> ❑ Deck ❑ 59.692(ly)Gazebo ❑ Camping Unit ❑Commercial Aa.Structure <br /> zi <br /> STRUCIURE/ADDTTION USE: STO�l6G IC Z <br /> � � (Home/Cabin;Commercial Business; Bedroom;Deck; etc.) <br /> TO <br /> BUILDING CONTRACR: /Y ,V,`/4901 i 1y✓�GI3Ti>% T�✓G r <br /> ry H <br /> PLOT PLAN ---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. a <br /> ***REOUIRED PLOT PLAN INFORMATION*** - <br /> ❑ 81/x"X 11"SHEET OF PAPER DISTANCE(IN FEET)TO: o <br /> Cl DRAWN TO SCALE OR DISTANCES LABELED Cl WELL <br /> ❑ PROPOSED BUILDING/STRUCTURE LOCATION ❑ SEPTIC TANK&DRAINFIELD <br /> dDimensions&Heights ❑ ROAD RIGHT-OF-WAY IF SURVEYED Im <br /> ❑ EXISTING BUILDINGS/STRUCTURES(Includes deck, porch, etc.) -)CENTERLINE IF NOT SURVEYED I ' <br /> -)Dimensions&Heights ❑ ALL PROPERTY LINES c 1_ <br /> ❑ NORTH ARROW ❑ ORDINARY HIGH WATER MARK <br /> ❑ ALL WETLAND AREAS <br /> NOTE: Building/structure location must be staked for onsite venfication when needed. <br /> THIS PERMIT 15 SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> • Removal ar cutting of trees and vegetation is restricted along shoreline <br /> • No structures(including retaining walls,etc.)are alloweo unless speofcally permitted <br /> • No filling,grading,or shore land alterations are allowed unless specifically permitted <br /> • Driveway must meet width requirements within 60 days of permit v <br /> • Accessory structure/garage permits allow for private residential storage only <br /> ­Not to be used for human habitation or rental storage" `= <br /> A <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to Me hest of my knowledge 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 acmmpanying schedule)and I further declare that I recognize that this information provided will be <br /> relied upon by Me county of Burnett Wisconsin in determining whether W Issue a permit 1 further accept all liability that may he a <br /> result of the county of Burnett relying on this information l 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 Me purpose of inspection. <br /> r > n ,^ o > c <br /> 3c <br /> --ADDITIONAL CONDITIONS--- F w 3 3 3 = 2 <br /> - fnza � � <br /> o . . 85 <br /> OWNER'S SIGNATURE / i //fL+✓C ��G / r; ria _ _ - <br /> oa. r, r <br /> (sate) <br /> ZONING OFFICIAL <br /> (sate) <br /> "TOWN/UDC PERMITS MAYBE 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 an 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 the law or other penalties or costs. For more information visit the Department of Natural ResogrCes <br /> wetlands identification web page or contact a Department of Natural Resources service center. r c 8 ' c <br />