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en c <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0W CD c o <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> d o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 'z N <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <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. - <br /> v E <br /> n O <br /> OWNER Ar�L S. � 4N rD� TELEPHONE 7/� R S651 <br /> ADDRESS T 7 CJD SWAAJ ngy� I��I�„ IAla�— _>L19_30 60 1 <br /> EMERGENCY/FIRE NUMBER /L!(fir. ROAD NAME JJJ <br /> 7 7 00 L .2 5 E1.- �o S <br /> LEGAL DESCRIPTION (see tax receipt) L!0T—2( C s� vGL YJ/ / <br /> P /(r T y� /J /2 ys 4l l� <br /> CONTRACTOR S' e.LF <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> J <br /> '^ r <br /> STRUCTURE/ADDITION USE: UT( 4I Tf °— <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z m <br /> a <br /> m <br /> 3 <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 drainfieid (DF). 0 <br /> 3. Show dimensions in feet 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. Q <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. f;7 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIO S MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I 3 rn <br /> PLOT PLANA 0 o a <br /> o <br /> J <br /> C I I <br /> m <br /> O <br /> 1 n <br /> N I� <br /> O <br /> J <br /> D <br /> m <br /> v <br /> �c -o 0 0 a a MU <br /> * <br /> A. Z' C8 CONDITIONS OF PERMIT: = y.: .z c g 0,o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F L <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =y 9 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. HNo 62i i rn <br /> I 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.I acknowledge that I am responsible for the detail and accuracy of all informa- '^m n'. m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. Di i i 9 <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 accep ility which mgy be a result of the County of Burnett relying on this information 1 am providing in this ap- <br /> plication. I agr a to pe coun s ch qe with administering county ordinances or other authorized person to have O N p <br /> access to the a ve descn r ises ata onable time for the purpose of inspection. 3 0 ' <br /> A N <br /> O M fA O <br /> SIGN HEREa ` <br /> (signal of owner or building c r to date) <br /> ZONING ADMINISTRATOR a5 Zg E <br /> y N N 41 N N N T <br /> TOWNSHIP PERMI MAY BE REQUIRED o a b v u v O rn <br /> 0000 $ 000rm// <br />