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r <br /> Burnett County 7410 County Road K,No. 102, Siren,WI 54872 Office of Zoning Administrator � C <br /> APPLICATION FOR LAND USE PERMITS ' <br /> OWNER //en M- GelawyAn TELEPHorvE�7la -�i33-D3/Z o <br /> PROPERTY ADDRESS <br /> -/.J�830 <br /> LEGAL DESCRIPTION U IOOnbbl"^IIS �P(y,�I,r //YI � ! <br /> MAILING ADDRESS L0�D AVONKI-e Sr . Min � <br /> ( t/\1µA� ) MN SS3-I.) <br /> TYPE OF PERMITIS): <br /> ❑ Single Family Dwelling FJ Garage/Accessory Structure U Stairs ❑Commercial Building Ov , <br /> U Addition ❑ Bunkhouse U Filling/Grading U Commercial Addition .� <br /> Cl Deck ❑/5`9.692(ty)Gazebo U Camping Unit LJ Commercial Acc Structure <br /> STRUCRIRFJADDITION USE: ( F`"'4yC• Ira o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z }- <br /> —6 .y z rljl <br />�- - UiL0ilrG CO.TRARCR: — .�/H YNR NYn 7T /Uz15 f/NL/ [ ol.I <br /> PLOT PLAN---INCOMPLETE OR ILLEGIBLE PLOT PLANS WILL BE RETURNED. _ <br /> **'REOUIRED PLOT PLAN INFORMATION*** m a <br /> Cl Blh"X I I"SHEET OF PAPER DISTANCE(IN FEET)T0: o <br /> Cl DRAWN TO SCALE OR DISTANCES LABELED ❑ WELL <br /> ❑ PROPOSED BUILDING/STRUCTURE LOCATION U SEPTIC TANK&DRAINFIELD ,. I <br /> 4Dimensions&Heights U ROAD RIGHT-OF-WAY IF SURVEYEDCP <br /> ❑ EXISTING BUILDINGS/STRUCTURES(Includes deck, porch,etc.) 4CENTERLINE IF NOT SURVEYED L_1 <br /> -)Dimensions&Heights ❑ ALL PROPERTY LINES <br /> Cl NORTH ARROW U ORDINARY HIGH WATER MARK 5. <br /> U ALL WETLAND AREAS I <br /> NOTE: Bitcling/structure location must be staked for olste verification when harder! s <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: ( �CD�.IIC <br /> Removal an aping of trees and vegetation is restricted atmg shoreline D <br /> • No structures(including retaining walls,etc.)are allowed unless spoifically i 1 <br /> No filling,grading,or shore land alterations are allowed unless spoifically p i OCT S 2014 <br /> • Driveway must meet width requirements within 60 days of permit S <br /> Accessory stnxiure/garage permits allow for private residential storage only rt <br /> "Not to be used for human habitation or rental storage" BURNETT COUNTY r, z <br /> P P <br /> I declare that this application(including any accompanying schedule)has been examined by mea a my knowledge and %- <br /> dand It Is true,correct and complete. I acknowledge Mat I am responsible for the detail and accuracy of all information contained in j'r/y,J, (J 1 <br /> this application(Intludi,g any acmmpnnying schedule)aM I turtner declare mat I recognize mac sii,infunnation y,uriJ✓lwll:w: I —news,upon by the county a Bument Wisconsin In determining whether m issue a permit I further accept all liability that may to a <br /> result ofthe county of remain relying on Mls Information l am Providing in this application. i agree to Permit county officials charged f <br /> with administratug county ordinances or other authorized persons to have access to the above-described premises at any reasonable <br /> time for the purpou of Inspection. <br /> nq annn �Q� <br /> —ADDITIONAL CONDITIONS--- <br /> 2 wu333 o <br /> o <br /> mnc_'w <br /> O/HAKE 5u a6 AYE SETB�cKS ARS rr/EET, S/Vct z n>m <br /> �m ami' <br /> /o' s��B�9cK To THE yoRrH�szOE� 6QT LswE. <br /> an It uuR <br /> 9aa14 <br /> OWNER'S SIGNATURE i m n p w q pl <br /> _ tel g Ji §C 526 _ Rf <br /> ZONING OFFICIAL �.,-�— �� /O ZO N 3 9.r o w <br /> di C: <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 mrlcerning construction rear or on wetlands, lath and streams. <br /> Wetlands that are Trot asdoc aced with open water con be diRlMt to identify. Failure to comply may result in removal or modification <br /> of construction that violates the law or other penalties ar costs. For more information visit the Department of Natural Resources in g o 0 0 8 <br /> wetlands identification web Page or contact a Department of Natural Resources service center. <br />