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nb ccs-) - <br /> 3urnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d A o 0 <br /> '- 3 <br /> APPLICATION FOR — LAND USE — PERMITS <br />'O THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <br />)cared as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m <br /> lurnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> 0 <br /> egulations of the State of Wisconsin. <br /> w <br /> '/,/n s yr c <br />)WNER I (^,(ie� /'/Jes�Q� 1 TELEPHONE/� !/�-��6 ^003 p b �� � � O <br />,DDRESS�•/`'4 7----///-„AV*4V G� ST• �4� ��/1! - J S�-2Z <br />:MERGENCY/FIRE NUMBER S9 ROAD NAME <br /> A C <br />.EGAL DESCRIPTION (see tax receiptlF 'HW" •F w,'iS O<w-�a P- mss fa-3 O w F �/.,,rsr. <br /> FF <br />;ONTRACTOR <br />-YPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE l ADDITION o ` <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION p o <br /> N <br /> f1' <br /> STRUCTURE/ADDITION USE: 1/E 36Z✓ m '� <br /> (Home/Cabi ,Commercial Business;Bedroom; Deck,etc.) o o <br /> a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). <br /> 2. Show the location of the well (W), septic tank (ST), and drainflaid (DF). ° <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building .4 <br /> measurement to the ordinary high water mark of lake,stream,or river. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> n <br /> dated by the owner. O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I 3 N <br /> 71 Z cc <br /> PLOT PLANtu <br /> f a , <br /> W <br /> Sr <br /> 3°r ►i m <br /> C� <br /> s I^ <br /> m <br /> y <br /> n <br /> i ke <br /> 3 ) � <br /> D � _ <br /> A1)b --- <br /> / <br /> m Tf <br /> 33m <br /> g� 2 a m e m <br /> CONDITIONS OF PERMIT: �" <br /> 1. DRIVEwA MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o £ 0, N <br /> 2. REMOVAL UT <br /> OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. d. 32Im <br /> 3. NO GRADING O ORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. p1 <br /> $ a C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> In <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this inlor- is p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $� X <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this ap- d, <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have 0, p <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 0 <br /> CD <br /> m m v <br /> SIGN HERE - « <br /> (signet o caner or Ing contractor) if (date) i ' '$ : <br /> o , , <br /> ZONING ADMINISTRATOR � � $ ' <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> N <br /> $ $ $ $ <br /> N <br /> F+ <br /> u+ <br /> O <br />