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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator w - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 5 3 . <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit forth e work " <br /> 0 y <br /> described and located as shown herein. The undersigned agrees that all work shall be done in accor. 3 0. <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. n <br /> OWNERTELEPHONE <br /> LA(2safJ �lZ 483 -`13 r <br /> HOME ADDRESS 5840 6XFoe o ST. SM CEV II_w IH.tV SIS <br /> I� J <br /> l ) <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) L o 7- 12 ' r9"Y~ YY,e h Q 8d, 6I^ `VI D e r\J I <br /> CONTRACTOR <br /> �j o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING+ _GARAGEIACCESSORY STRUCTURE ADDITION 0 »- <br /> N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIV SION 'o <br /> ZJr <br /> a <br /> STRUCTURE/ADDITION USE: C"TO A �ke-' m z v <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> r <br /> 0 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n <br /> 0 Y' <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 3 <br /> "n 'P rn <br /> 1. All required dimensions or distances to be shown or drawn to scale. F)o $ <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate m H: <br /> North (N). C ° <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of m V _ <br /> road, (c) building(s) measurement to the ordinary high water mark (OHWM) of lake, stream or river. -X)1 <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildings, <br /> uildi gs, e <br /> roads, lake, lot lines. 61') <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. 2-1 <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be <br /> signed and dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMI <br /> ISSUANCE. G �) <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY �, D <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF 7 HE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. II '' <br /> 6. + ly-ct-- S �� A\\ <br /> Nfn� mrDD � <br /> 7. o c '<" > > � n m <br /> 6. = F ' ' "� 31 <br /> o - � m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my o ' ' : u7 <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of : i : ' d@ d': m <br /> 9 P 9 P Y � u+ m u+ ; O <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Information I am . n p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances oi other 3 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. ,n m <br /> m : <br /> N N <br /> SIGN HERE H <br /> N <br /> (sign ureof"nerorbulldin co <br /> ZONING ADMINISTRATOR [ [ <br /> ILL n <br /> TOWNSHIP PERMITS MAY BE REQUIRD SEP T N N U N N N m <br /> 0 6 O i N n t m <br /> 000000 fA <br /> — - - <br /> IL <br />