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r <br /> Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of coning Administrator <br /> APPLICATION FOR LAND USE PERMITS - <br /> OWNER <br /> TELEPHONE <br /> PROPERTY ADDRESS \O V p <br /> LEGAL DESCRIPTION <br /> MAILING ADDRESS <br /> TYPE OF PERMIT(S): v: jy <br /> 0 Single Family Dwelling 0 Garage/Accessory Structure O Stairs CJ Commercial Building _ <br /> 0 Addition Cl Bunkhouse 0 Filling/Grading 0 Commercial Addition .� <br /> 'r¢Deck 0 59.692(ly)Gazeta ❑ Camping Unit ❑Commercial Add. Structure '+ <br /> STRUCTURE/ADDMONUSE: <br /> (H me/Cabin;Commercial Business; Bedroom; Deck;etc.) -fllW_ <br /> BUILDING CONTRACTOR: <br /> 9 <br /> PLOT PLAN --- INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. N <br /> """REQUIRED PLOT PLAN INFORMATION-" � b <br /> 8'V"X 1l"SHEET OF PAPER DISTANCE(IN FEET)TO' T_m 1 <br /> DRAWN TO 55A OR DISTANCES LABELED Cr- WELL — S <br /> ig PROPOSED BUILDING/STRUCTURE LOCATION SEPTIC TANK&DRAINFIELD <br /> 4Dimensions&Heights .p ROAD RIGHT-OF-WAY IF SURVEYED o <br /> sS EXISTING BUILDINGS/STRUCTURES(Includes deck, porch,etc.) 4CENTERLINE IF NOT SURVEYED - <br /> 4Dimensions&Heights 0 ALL PROPERTY LINES o <br /> __. <br /> W_NORTH ARROW L'I_ORDINARY.HIGH.WATER MARK_ _o,_ <br /> ❑ ALL WETLAND AREAS �J w <br /> NOTE: Builtling/structure location must be staked for onsite verification when needed. D T�(T ���1'C, <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 'Lk+}aC u[ D ( y <br /> • Removal or cutting of frees and vegetation is restricted along shoreline <br /> • No shuRures(indWing retaining walls,etc.)are allowed unless spe tfically permi pUG 1 2014 <br /> • No filing,grading,or stare land alterations are allowed unless specifically permit <br /> Driveway must meet width requirements within 60 days of permit <br /> • Accessory structure/garage permits allow for private residential storage onlygURNETT COUNTY Z 1 <br /> - <br /> ­Not to be used for human Initiation or rental Borage'" ZONING @ a <br /> I declare that this application(including any acmin"minP schedule)has been eaamlned!by me and to the best of my knowledge and -INTI <br /> belief It Is tsu4 carmot and complete. .aekrwwledge that I am r6poeslble for ted detail add amrary of all information contained in <br /> this applierbon(including any accompanying scheduk)and I further declare that I radia lze that this Information Provided will be <br /> relied upon by the county of Burnett Wisconsin In determining whether to Issue a Permit. 1 further accept all liability that may be a <br /> resuh of the county ofBurnett relying on His information am margins in this applkatba I agree to Permit county officials charged f <br /> with administrating munty ordinances or What authorized Persons to have sooner to the abme-described Premises at any reasonable <br /> time for the Purpose of inspection. <br /> Hrynnnn�o <br /> ---ADDITIONAL CONDITIONS--- <br /> -771 <br /> /IN115 15 CI( /l T� an <br /> {IQS P_Ny'07'S 477✓• WtPM SIO AS. P 6'E ow <br /> �Q/� 211 1` � v�� SB ogo 'y <br /> OWNER'S SIGNATURE '` \L \ <br /> (d tel 9 (ju §�. w e y <br /> ZONING OFFICIAL I ZD� <br /> ( ate) RIZ : _°d : o n <br /> m E a <br /> ­TOWN/UDC PERMITS MAYBE REQUIRED "'THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE Roo,\7I\ 5 <br /> You are responsible for plying with state add federal laws mncemilg construction near or on wetlands, lakes, and Breams. <br /> comg w <br /> Wetlands that are not assddated with open water can be difficult m identify. Failure to comply may result in removal or modification <br /> of cons ichon that violates Me law or other Penalties or mats. For more information visit the Department of Natural Resources U S <br /> wetlands identification web page or contact a Department of Natural Resources service center. 'oX <br /> l <br />