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on coy)\_ , <br /> Burnett County 7410 Co. Fid. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m c a <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 9 <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 3 <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and tom. <br /> Cy <br /> regulations of the State of Wisco isin. H o <br /> w ,^y <br /> c <br /> m O <br /> OWNER TELEPHONE ' £ <br /> Pete Jelwen o <br /> m " <br /> ADDRESS Box 477 OtSon and <br /> EMERGENCY/FIRE NUMBER ROAD NAME Okaon Road <br /> LEGAL DESCRIPTION (seetazrec ipt) PaAceK NW 114 NE 1/4 S11 T39 R77W LinCotn Township <br /> CONTRACTOR I �I <br /> TYPE OF PERMIT(S): DWELLING/ UILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n L1 <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 ° <br /> STRUCTURE/ADDITION USE: anitaAq Ont g <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z o <br /> 0 0 <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 thew II (W),septic tank (ST), and drainfield (DF). o <br /> 3. Show dimensions In feet oft efollowing:(a) building to all lot lines,(b)buildingto center line of road,(c)building q <br /> measurement to the ordinary high water mark of lake,stream,or river. 0 N\1 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 2 <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCNTIONS MUST BE STAKED FOR ONSrTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '1I 3 rn <br /> �I Z <br /> PLOT PLAN A o n <br /> m <br /> 0 <br /> r i <br /> w <br /> m <br /> 0 <br /> 0 <br /> SEE ATTACHED ' <br /> o <br /> o <br /> 2 <br /> (� z <br /> f <br /> Wc�Nrcni a � 'V <br /> A. Dg� 2. 2Q' 0 MM <br /> CONDITIONS OF PERMIT: ^ < h' Z S 8 gro i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F o <br /> 2. REMOVAL OR CUTTING CF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �' O' �'" ' m <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.1 acknowledge that I am responsible for the detail and accuracy of all informa- «r m m <br /> lion contained in this applicati n(including any accompanying schedule)and I further declare that I recognize that this infor- iia G <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <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 havei Oa v <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 - w : <br /> m v $g0 <br /> m w <br /> y Apct2 26, 1994 '" - : 5 <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) <br /> o a� <br /> ZONING ADMINISTRATOR I `✓: E E * E iK <br /> f' APR 2 7 x x„ <br /> �ggq <br /> TOWNSHIP PERMITS MAY BE REQUIRED ommc�x m <br /> u 888� m822g <br /> x xx x <br />