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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> m a � <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the c c <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. y d <br /> OWNERTELEPHONE t f <br /> 71s- r/s�_ <br /> ADDRESS a f m <br /> 1 <br /> EMERGENCY/FIRE NUMBER ' _ r 4.7 7,eOADNAME / <br /> r <br /> LEGA DESCRIPT ON as tax re//i /�f: TWO r <br /> usol.... - Chid-+-�, <br /> CONTRACTOR _d� ,S UI amt <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n Ll d <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> 0 <br /> `^ r <br /> STRUCTURE/ADDITION USE: o ° <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) _ -- <br /> yIJ 1 <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 (MI),septic tank (ST), and dralnfield (DF). o <br /> 3. Show dimensions in feet ofthefollowing:(a) buildingto all lot lines,(b)building to center line of road,(c)building <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 /> dated by the owner. <br /> 00 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 a w <br /> PLOT PLAN (� �Y �� �� n o n <br /> /00 , l in <br /> w - <br /> ) <br /> t b <br /> m <br /> V <br /> V <br /> N <br /> m <br /> a,eJc <br /> 1 <br /> f <br /> 1 1 <br /> afse <br /> . 't`� hl . I n �N��rD <br /> 1 . <br /> n <br /> CONDITIONS OF PER IT: LQ c 8 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY YID F�] I ENF� ]THIN 60 DAYS OF PERMIT ISSUANCE. 1 0 0 S520 �`z 1 <br /> 2. REMOVAL OR CUTTING OF TREES A G TION IS R RICTED ALONG SHORELINE. —N M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS717111- W UNLESS SPECIFICALLY PERMITTED. { o p <br /> o : a� <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. o': R ia : C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs. '^w" m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 'off o <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- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have O N o <br /> access to the above described prervises at any reasonable time for the purpose of inspection. m 3 'oo <br /> y m A y <br /> J « o <br /> SIGN HER r � � J � E «: B <br /> (sign r of owner or b Iding contractor) (date) <br /> it i <br /> ZONING ADMINISTRATOR 0. g <br /> TOWNSHIP PERMITS MAY BE REQUIRE I'U v k o P N N N ol,m <br /> 00ogoo 0 <br />