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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator ( - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work y <br /> described and located as shown herein. The undersigned agrees that all work shall be done in accor- 1D (`g <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other 3. <br /> v <br /> applicable <br /> //County Ordinances and the laws and regulations off the State of Wisconsin. m _ O� <br /> FL <br /> OWNER /,_qPg / P /7 a� A/Nf gfok TELEPHONE /L��` air / ^p <br /> CVVJ� T <br /> CD <br /> HOME ADDRESS <br /> EMERGENCY/FIRE NUMBER /�{f fJ� ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) !PC f L f Ire <br /> -C � t. SISI <br /> CONTRACTOR L J <br /> O <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION 0 <br /> m r <br /> SANITARY PRIVY FILLING/GRADING CAMPINGUNIT__tX SUBDIVISION c $ _ <br /> STRUCTURE/ADDITION USE: �D!'Lf�f'SGc /t'I 1 '4*dC dec 6 A O �c a/_ T <br /> (Home/Cabin;Commercial Business; Bedroom; k;et ) <br /> N41'0111o —} <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. m <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 3 <br /> co <br /> T Z <br /> 1. All required dimensions or distances to be shown or drawn to scale. m o <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings (NB) and indicate y. <br /> North (N). m <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. r, <br /> 4. Show the location of the well(W), septic tank(ST)and drainfield (DF), and all distances to buildings, <br /> roads, lake, lot lines. �. <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be <br /> signed and dated by the owner. <br /> 11's 8 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE A PERMIT CAN BE ISSUED. U <br /> o <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. co <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT C1J <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE I <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. N <br /> 5. <br /> 6. �Gdf f/ vl� �s 0a =. ) �Wm <br /> �ee <br /> W m <.: dCwO � 3 <br /> m'o �D0Da <br /> 8. Z M <br /> ° - m <br /> � c�= i <br /> of SCE C_ <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of w v D <br /> oro o : <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize (D b , <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- $ o <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information 1 am ; c. p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 <br /> authorized perso to have ccess to the above described premises at any reasonable time for the purpose of Inspection. TCDE <br /> SIGN HERE jW <br /> (al tur of owne o uilding contractor) I I (date) o f E <br /> JIM Z O o ° . <br /> ZONING ADMINISTRATOR t `((qq <br /> F ' �N N M" o Cn rn <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 0go m <br /> 0000000f!! <br />