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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator d m -- 0 <br /> APPLICATION FOR LAND USE PERMITS w 3. o <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 actor- M <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. CD <br /> H <br /> OWNER TELEPHONE p <br /> (.�i l l i p m ,Krum-r�&X)f) I �nc�bl om i a a y s o 7 a, <br /> HOME ADDRESS /-/&4/ <br /> EMERGENCY/FIRE NUMBER ' t / I ROAD NAME <br /> lo p627 <br /> /0.0'Q <br /> QGn Q r5on <br /> 3 <br /> ) S27 - / 3r �/6l &n <br /> LEGAL DESCRIPTION(see tax receipt � <br /> -o®uznncTt7Re' 1 O'p /Y G114e L/91)L <br /> R))s_s i (j en-r Ho meS tillp,Cs . /Am • <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION 0 �- <br /> N � <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> - <br /> Z° <br /> CD <br /> STRUCTURE/ADDITION USE: �?D M`t✓ o�01 Amm U I[/J( t/tom CS i(J�ry � � 1 <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. �l <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> m p rn <br /> T o i <br /> 1. All required dimensions or distances to be shown or drawn to scale. i <br /> M <• <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB) and indicate y <br /> North (N). (a <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. so <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. m <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE A PERMIT CAN BE ISSUED. <br /> N <br /> 0 <br /> _ <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <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 THECIO <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. 7/9& <br /> oin= iudR � 0m <br /> 7. m <br /> ae am . <br /> icy o 9 <br /> ID O P_`2 <br /> 8. ° m <br /> c)� !J <br /> o . C <br /> o ? ? m m ; E C <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my O ` M <br /> i»w cn m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of °, w �„ , O <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o o <br /> o , o : <br /> that this Information I am providing will be relied upon by the County of Bumett Wisconsin in determining whether to is- <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 x <br /> authorized person to have access to the above desert ed premises at an asonable time for the purpose of Inspection. CD <br /> N <br /> SIGN HEF//i\U AW& m - Z w <br /> N; <br /> ;. t <br /> (signature of owner or bull ng contractor) LS o <br /> ZONING ADMINISTRATOR <br /> { <br /> ! l � 2 5 y IN tnNNNfn m <br /> TOWNSHIP PERMITS MAY BE REQUIRED u o p u u o <br /> d 0c �/f �� <br />