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Burnett County 7410 Co. Rd. K. No. 102, Siren, WI 54872 Office of Zoning Administrator S f o <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 u c <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 <br /> 0 <br /> regulations of the State of Wisconsin. " m <br /> TELEPHONE f <br /> OWNER 7iS- 653 - ASSY m �( <br /> 111 r7 pp !� n /� �y8 -3-7 - 9�a <br /> ADDRESS a'�03CI JOI�SeN �+� t �/LP.�A �LC� Wl - ( � <br /> EMERGENCY/FIRE NUMBER �1 93 3 -1 ROAD NAME -<,14 9J$o N /1"/J of- l <br /> LEGAL DESCRIPTION (see tax receipt) C J eLf� cop, op. A Qu C'/CTL g v Ib(L�9 A. "'b trt oo / (I-0n <br /> p U' <br /> CONTRACTOR Ray &-f4ttlEL (.OMS1k.Nc-744w -ConrcRt zt.WOV a .A-&C c-'A oWM4IL <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ACCESSORY STRUCTURE_ ADDITION O <br /> n O rb <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> N r1 <br /> 0 <br /> STRUCTURE/ADDITION USE: Q/h r, o� <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o 0 <br /> v <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or tap 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 dralrlfield (DF). I 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. Q <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. o y <br /> Z o <br /> PLOT PLAN o n I <br /> A s. <br /> A 0 <br /> l <br /> � <br /> � � - <br /> 1 LtT 14 d 02/CrlN� <br /> (�gLZAWe wtw � f✓ 100 �o <br /> I <br /> wt�t � �pw �r_�t-fra ) �Nt� �3t F2orn <br /> N <br /> LfN�- � <br /> E Si Ct 13du#4� K o <br /> T' 0 <br /> m � <br /> I� 1 <br /> o <br /> I� <br /> �Q <br /> ( <br /> m FL <br /> M <br /> Z: Q ; <br /> CONDITIONS OF PERMIT: 0 4 i � ' =i <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 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 PERMITTED. <br /> QE C <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowl- E S <br /> of <br /> N «: m <br /> edge and belief It is true,correct and cOmplsla.I acknowledge that I am responsible for the detail and accuracyall informs- <br /> - <br /> nform <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize that this Infer O <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a Permit. 1 <br /> further accept all liability which may be a result of the County of Bumett 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 parson to have <br /> access to the above described promises at any resso le time for the purpose of Inspection. T <br /> w : <br /> i <br /> N: <br /> SIGN HERE ; E <br /> IgmalU O OWMr OI Ing contractS6 <br /> 8 <br /> ZONING ADMINISTRATOR <br /> TOWNSNIP PERMITS MAY BE REQUIRED ' I 8 8 8 8 8 t3 I8 H <br /> tl Ks <br />