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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m o 0 <br /> E <br /> APPLICATION FOR — LAND USE — PERMITS m s <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and o _ <br /> regulations of the State of Wisconsin, w m <br /> OWNER s /1 TELEPHONE <br /> O& UIQ l �thd� ,A lP/z 5a3 Sam o <br /> ADDRESS /7 S � � cr 04 11C4 m" <br /> EMERGENCY!/FIIRE-N�f l SdSd S.�g` ROAD NAME Cd�h �y 17�e <br /> LEGAL DESCRIPTION (see tax receipt) `(-L1• <br /> // uI ,v1 II � <br /> CONTRACTOR P6, los&4.I�QC,c 191�Z) tall �ttnr0(wI'44�• .SV33o <br /> TYPE OF PERMIT(S): DWELLING/BUILDINGGARAGE/ACCESSORY STRUCTUR ADDITION p —' <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION "' <br /> a .sli1 >. fi Yaa-/ �!•,,.,.��.. r <br /> " . <br /> STRUCTURE/ADDITION USE: �Gb... � tFa� POWL u>=s+ t+... G,C... t+ >,_&,.A ..; gym. o o <br /> (Home/Cabin Commercial Business;Bedroom;Deck;etc.) Z 0 <br /> 0 0 <br /> a <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 draintield (DIF). <br /> 3. Show dimensions Infest of the following:(a)building to 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 M <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '1I o ur <br /> PLOT PLAN A o a <br /> m �^ <br /> 0 <br /> C <br /> A m Z <br /> a <br /> z <br /> I <br /> 6 <br /> i N <br /> I � <br /> } A� .I r o <br /> a <br /> i <br /> o y <br /> Ac <br /> D fn rnr DDp <br /> m <br /> CONDITIONS OF PERMIT: C. m ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ p <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- _ O <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize that this infor- a I: m <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I . i 8 u g <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 a - <br /> access to the above dfiscribed promises at any reasonable time for the purpose of inspection. r 3 g <br /> m O A m <br /> SIGN HERE `"- ;R <br /> (si not re owner o ilding contractor) i� tii� - '^ f� i5 <br /> ZONING ADMINISTRATOR -� _ i I ' g ' Fr' <br /> TOWNSHIP PERMITS MAY BE REQUIRED qpR - ri _ i0 0 N 0 o o- m <br /> RV 8888888 w <br />