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&)Oq) <br /> BuFtrott County 7410 Co. lid. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m a o <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � rn <br /> J <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m c <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations Of the State of Wisconsin. <br /> F- x ivu lj �oI COUI S� <br /> OWNER � TELEPHONE <br /> 71S <br /> � �m <br /> ADDRESS 6sJer/ <br /> EMERGENCY/FIRE NUMBER '7S 2 / ROAD NAME <br /> LEGAL DESCRIPTION (see tax ret ipt) Sw (0 ill <br /> irk pW,� <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): UILDIN� GARAGE/ACCESSORY STRUCTURE ADDITION p Z <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> o Q.. <br /> STRUCTURE/ADDITION USE: - - -4— ��i (%'. �- Gy o' ° <br /> (Home/Cabin;Cb1mmercial Business; Bedroo ;Deck;etc.) Z v <br /> o ° <br /> 0 <br /> DIRECTIONS FOR PLOT PLA14 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). T� <br /> 2. Show the location of the II (W),septic tank (ST), and drainfieid (DF). <br /> 3. Show dimensions in feet of I he following:(a)building to all lot lines,(b)building to center line of road,(c)building " <br /> measurement to the ordinaiy high water mark of lake,stream, or river. <br /> 4. If separate plans are submi ed 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 LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. MR 3 to <br /> c <br /> PLOT PLAN n o n <br /> M ° <br /> C <br /> fA _I-_ <br /> M w <br /> c <br /> ui <br /> N <br /> n <br /> �1 <br /> 0 W <br /> x] <br /> 9 � <br /> N <br /> Z <br /> A O,C d r O aO -v <br /> M D � 2. a= y <br /> CONDITIONS OF PERMIT: 2. C o 0 <br /> ,z <br /> t. DRIVEWAY MUST MEET D IVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F'0 �� -1 <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. <br /> �M 62:: m <br /> o : B <br /> 1 declare that this application(ii eluding any accompanying schedule)has been examined by me and to the best of my knowl- ^: e <br /> edge and belief it is true,correc and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- _ «.y.n m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be mlied 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-plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O m o <br /> access to the above described premises at any reasonable time for the purpose of inspection. m b m <br /> m 3 A r <br /> SIGN HERE <br /> (signature of owner or building contractor) I r'w` (date) <br /> ZONING ADMINISTRATOR <br /> Fhn ; <br /> T <br /> TOWNSHIP PERMITS MAY BE REQUIRED m <br /> N u <br /> i <br /> - 000 0000y <br />