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r <br /> Burnett County 7410 County Road K, No. 102, Siren,WI 54872 Office of caning Administrator - C <br /> APPLICATION FOR LAND USE PERMITS - <br /> - A <br /> OWNER - _ <br /> Bo)yn) wAi TELEPHONE <br /> PROPERTY ADDRESS 2801/ TOHA60,V LIC el> Wei A)T- Sy 893 0 <br /> / <br /> � 1 0 <br /> LEGAL DESCRIPTION * (LL 6nL 5• -K, Zs�4/ C$N'tY, zs ./r.9V 23-Bio -/6 _ 'w <br /> MAIUNGADDRESS Ir//U 65r ii /1/si I / �oO�e vRvovp. /r�iV .SS769 <br /> `Yl /" iV i s <br /> TYPE OF PERMIT(S): <br /> -tJ,Sinqle Family Dwelling ❑Garage/Accessory Structure ❑ Stairs J Commercial Building <br /> J Addition J Bunkhouse Filling/Grading ❑Commercial Addition N <br /> J Deck ❑59.692(ly)Gazebo J Camping Unit J Commercial Ace.Structure 2s <br /> STRUCTURE/AWTTIONUSE: IIcpGa�,nh Nowte/c-61A <br /> i <br /> /'(HomeCbin;Commercial Business;BedroomDeck;etc.) <br /> SLIMING COMPACTOR: rdlyNSTyU1,17,�A — a<i Pk <br /> s I; <br /> - __ 3Z oby G cn H✓ W 830 - r <br /> _M 3 <br /> PLOT PLAN---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> ***REQUIRED PLOT PLAN INFORMATION*** <�3 p <br /> J 81h"X 11"SHEET OF PAPER DISTANCE(IN FEET)TO, (r � <br /> ❑ DRAWN TO SCALE OR DISTANCES LABELED ❑ WELL <br /> ❑ PROPOSED BUILDING/STRUCTURE LOCATION Cl SEPTIC TANK&DRAINFIELD O <br /> 4Dimensions&Heights ❑ ROAD RIGHT-OF-WAY IF SURVEYED T <br /> N <br /> ❑ EXISTING BUILDINGS/STRUC-URES(Includes deck, porch,etc) dCENTERLINE IF NOT SURVEYED <br /> 4Dlmenslons is Heights ❑ ALL PROPERTY LINES c Q <br /> J NORTH ARROW ❑ ORDINARY HIGH WATER MARK 6\ <br /> ❑ ALL WETLAND AREAS <br /> w <br /> NOTE: Builtling/structure location mus[be sulked!for onsite verification when needed. JO (V s <br /> Jo W ' <br /> THIS PERMIT IS SUBJECT TO ALL CONDII]ONSLISTEDd along _ y <br /> • Removal or attirg di g res anti vegetation is restricted along shoreline It (H <br /> • No structures gra(induding re l retaining walls,etc.)are xlwed noses spxically Permitted .(\ 9 1 <br /> • No filling,grading,or shore land alterations are allowed noses specifically permitted Q Jr Oo <br /> • Driveway most meet width requirements within 60 days of permit <br /> • Accessory structure/garage permits allow for private residential storage cny S h <br /> **Not to be used for human habitation or rental storage— <br /> z N <br /> I declare that acb rrect a d c mpletemy any <br /> imated a met lam responsible <br /> leen examiMe de ed by a am,to the beat mi at onawlMpe contained in <br /> belief it is tm4 tinted and complete. I acknowledge Mat I am ober 9ble Ter ace Irbil and actuarys I all Imaion proides in <br /> this application(including any accompanying n in dee)and I further whether <br /> Na[I recognize that the tacc Information provided will be N <br /> relief upon by Me County of Bumrtt Wn this in in determining nn a lin m Issue a permit I mato accept an liabilitytyli acct may be a <br /> result of the County at pumett relying on Mlz r authorized <br /> I am providing In acts ss W ti fon-1 a��e bfinsia t�WtII1IYuN,aa-Is�arpM <br /> with for <br /> of hapentien. cs or Miner auModxel perzons to have accessmtee'abo`ve•de`cfibal prerq f{at5nyi nable <br /> Icor rot ace purpose of inspection. I J 9`�/> VVVV �I _ <br /> ---ADDITIONAL CONDITIONS--- / ton a 3 P - <br /> - See avr'ea — Z s�ee�s, L OCT - 9 2014 _ ta <br /> BURNETT COUNTY <br /> ZONINGEg <br /> N r <br /> 3 <br /> (J 10 & ZOII f <br /> OWNER'SSIGNATURE p T <br /> (dat <br /> ZONING OFFICIALra <br /> *TOWN/UDCP [TS 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 streams. m <br /> Wetlands that are not associated with open water ran be difficult to identify. Failure to campy,may result in removal or modification <br /> of ronstruchan that vartates Ne law or other penalties or costs. Fiat mere information visit the Department of Natural Resources I�V1+ <br /> wetlands identification web page or contact a Oepanment of Natural Resources service center. _ _ _ <br />