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Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of Zoning Administrator `c C <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER 2. <br /> De Iyl; �IZ1 e/ti/+NN TELEPHONE /�/_ /jS V-I lIV <br /> PROPERTYADDRESS G arOo // r <br /> 9552 w�7/ Nienho � ckc \_OAd <br /> LEGALDESCRIPTION IGT I SOLI f o^ 3 S�G�' I6WN JNfP a <br /> N° <br /> t <br /> c <br /> MAILING ADDRESS <br /> C--IGS E aOWMAN V2 _j4_VvRIL GKcVZ Neygl17s <br /> TYPE OF PERMIT(S): <br /> ❑ Single Family Dwelling ;6(Garage/Accessory Structure ❑ Stairs U Commercial Building —( <br /> ❑ Addition Cl Bunkhouse ❑ Filling/Grading LI Commercial Addition .a 1 <br /> ❑ Deck ❑ 59.692(ly)Gazebo <br /> ❑ Camping Unit ❑ Commercial Acc.Structure _ <br /> STRUCfUREIADDITION USE: GIArQ�JGG <br /> (Nome/Cabin;Commercial Business Bedroom; Deck; etc.) P - <br /> BUILDING CONTRACTOR: <br /> m � <br /> n <br /> PLOT PLAN ---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> ***REQUIRED PLOT PLAN INFORMATION*** QlY <br /> ❑ 81/2"X 11"SHEET OF PAPER DISTANCE(IN FEET)TO' <br /> ❑ DRAWN TO SCALE OR DISTANCES LABELED ❑ WELL _ <br /> ❑ PROPOSED BUILDING/STRUCTURE LOCATION ❑ SEPTIC TANK&DRAINFIELD r <br /> ->Dimensions&Heights - Cl ROAD RIGHT-OF-WAY IF SURVEYED N yJ <br /> ❑ EXISTING BUILDINGS/STRUCTURES(Includes deck, porch, etc.) 4CENTERLINE IF NOT SURVEYED UJ <br /> Dimensions&Heights ❑ ALL PROPERTY LINES <br /> U NORTH ARROW ❑ ORDINARY HIGH WATER MARK (II <br /> U ALL WETLAND AREAS <br /> NOTE: Building/structure location must be staketl for onsite venfcatlon when needed. `s O <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> i <br /> • Removal or meting of trees and vegetation is restricted along shoreline <br /> • No structures iintluding retaining walls,etc.)are allowed unless spedcally Permitted <br /> IIIk`�j'^ i <br /> • No filling,grading,or shore land alterations are allowed unless specifically permitted <br /> • Driveway must meet width requirements wiNin 60 days of permit _ <br /> • Accessory structure/garage permits allow for private residential storage only <br /> "Not to be used for human habitation or rental storage" <br /> IA <br /> I dMare that this application pp bon(intluding any mwledge thurt sN respa has been esamlnail by a Cu to of best or my on Can knowledge and <br /> belief itis true,correct and any <br /> accompanying <br /> I acknowledges)a lam responsiblere tee detail and athat tTs i all information <br /> provided! <br /> will <br /> in <br /> this d upon by (including any accompanying schedule)and x further declare that I recognize that this information kaon y that tl will be <br /> result upon by the County of Burned Wisconsin in information <br /> I am whether to Issue a permit I further accept all liability that may r e a <br /> resultofthe inhCounty county or relying o or <br /> rauthorizex erprovidingin Miea,to th an. [agree to Permit moneyorfidalacha9ed £ <br /> with a it the trrpos county ordinances or other authorized persons to have access re the above-0ezcdbetl Premises at any reasonable <br /> time for the purpose of inspection. <br /> � rrnnr, n > - <br /> ---ADDITIONAL CONDITIONS- ia <br /> - ^ <br /> ane <br /> AThT5; Iau, /rvblGAiEb gr4_gss >401v 0' sef&� I k- 7b �`� - <br /> �RnuvHEID, to✓laer�D ank ^onF,Eo = d= <br /> -Y&og S"Ivy. 0,•n/ER Td cP•✓>9a�� lvoR/7/.Uy7� JUL - 7 2014 c 5 <br /> ru DNR q6-7_10A&_0A&_ ° <br /> BURNETT COUNTY <br /> OWNER'S SIGNATURE <br /> ZONING OFFICIAL zi <br /> �— (date) <br /> "TOWN/UDC PERMITS MAYBE REQUIRED --THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> You are responsible for complying with state and federal laws Concerning construction near or on wetlands, lakes, and screams. <br /> Wetlands that are not associated with open water can he difficult to identify. Failure to comply may result in removal or modification g ' <br /> of construction that violates the law or other penalties or costs. For more information visit Ne Department of Natural Resources - _ _ <br /> wetlands identification web page n contact a Department of Natural Resources service center. <br />