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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator d o 0 <br /> APPLICATION FOR LAND USE PERMITS I 5 <br /> � 3.TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the n <br /> work y <br /> described and located as shown herein. The undersigned agrees that all work shall be done inIg <br /> ccor- <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other - o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> go L1e�J 0. 1 l r r &12 - 9 ZO- 03 � <br /> OWNER TELEPHONE ^p <br /> HOME ADDRESS <br /> 13 S 64.,00 I of L ���•.�.. M.. S�'I Z SL..� `., <br /> EMERGENCY/FIRE NUMBER ROAD NAME ri I <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR Cwt ( Ol- �'� / 'Or 40 Ile r„eS o �' <br /> TYPE OF PERMIT : DWELLING/BUILDINGGARAGE/ACCESSORY STRUCTURE ADDITION <br /> r C7 <br /> N O <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> 0 v° <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Comme ial Business; Bedroom; ck; etc.) pQ. <br /> r <br /> � o <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE O <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In <br /> o Y3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> -n P ai <br /> n Z v <br /> 1. All required dimensions or distances to be shown or drawn to scale. n P o <br /> 2. Show the location and size of all existing buildings(EB) and all new buildings (NB)and indicate mSU 0 <br /> H <br /> North (N). y <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of m <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. --C x <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildi gs, Cr <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. r� <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE_ I� <br /> FORE A PERMIT CAN BE ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. C <br /> CONDITIONS OF PERMIT: o <br /> 3. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <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 Z <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF I HE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> S7r«�FLL ( lu�Y,y de�4Cs�1)0,4, e��. <br /> 7. ya� ayin <br /> v <, <br /> E. '200'2o <br /> .. m � `� E E 1 <br /> 8. <br /> T»: m <br /> of G O <br /> o <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief It Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of - ,d'„ D <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- <br /> o ; o : <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Information I am O p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. <br /> e tZi <br /> m <br /> SIGN HERE <br /> (sl at of owner or building contractor) (date) o E <br /> ZONING ADMINISTRATOR <br /> Fn Fs T fl <br /> + NNtn NN P, m <br /> TOWNSHIP PERMITS MAY BE REQUIRED o m m 00 o ao o m <br /> ---- o0000000 V/ <br />