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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m � o J o <br /> APPLICATION FOR LAND USE PERMITS '� � f <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 w rk shall be done in aceor- m ` <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanita ion Code,and with all other �� �' <br /> applic bl ounty Ordinances and the laws and regulations of the State of W sconsin. H d <br /> �or � s ,�-f1 . �1� ha bey' 1 / � <br /> OWNER -�/{ d YYt a S W. l i � a/ r� -y�� TELEPHONE�S� � ✓J_ / � t/� m <br /> �1 (o 'T o m <br /> `]� m <br /> HOME ADDRESS � J �T� � 2 �P 'lam �7" e'l � r U Y' ''I�e, ri 9 n�n11 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> Y../ <br /> LEGAL DESCRIPTION(see tax receipt)5/,v y�! ,(/GU SQ•� I$ T��qN Q�� Ld�SJ%ir� (� �� I <br /> CONTRACTOR �I � I ._7l'� <br /> p <br /> �� � o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE I�_ADDITION�CC,� <br /> � r <br /> m 0 <br /> SANITARY PRIW FILLING/GRADING CAMPI G UNIT_ SUBDIVISION '� <br /> STRUCTURE/ADDITION USE: �� �C-Wl�,T1 ) 1 11r l� I � <br /> (HomelCabin;Commercial Business; Bedroom; Deck;etlC.) <br /> II <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. NY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. �I m <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) I O 3 <br /> I T P m <br /> T o a <br /> 1. All required dimensions or distances to be shown or drawn to scale. n <br /> 2. Show the location and size of all existing buildings (EB) and all new buildin�s(NB) and indicate m H' <br /> North (N). ! y <br /> 3. Show dimensions in feet of the following: (a) buildings) to all lot lines, (b) I�uilding(s)to centerline of m I <br /> road, (c) buildings) measurement to the ordinary high water mark (OHWM of lake, stream or river. Q.1� <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�illed. �-- <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be �j j C <br /> signed and dated by the owner. t � �, <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONS�TE VERIFICATION BE- Q � ?r <br /> FORE A PERMIT CAN BE ISSUED. ((�� �� RR <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. ,o <br /> � I <br /> CONDITIONS OF PERMIT: � o � <br /> N YY�� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN�0 DAYS OF PERMIT u I,I <br /> ISSUANCE. .�, �" <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTE ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY I�, , ? <br /> PERMITTED. \N D <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED 1kVITHIN 75 FEET OF THE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> I � <br /> 6. <br /> N(n vinr D O 'Q <br /> S o, c �. > > �� m <br /> _ m <br /> 7. it m m g� m Cy o � 9 <br /> Z fes : TN; A <br /> 8. I c _ .. <br /> i ini i � c i m <br /> i O i m 0 <br /> i a � E i C <br /> P' m m . <br /> I declare that this a Iigtlon includin an accom n in schedule has been examin d me and to the best of m � ` �m E m <br /> PP ( 9 Y Pa Y g ) by Y <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsib a for the detail and accuracy of N m �,^, ? O <br /> all information contained in this application(including any accompanying schedule)and further declare that I recognize ' o� o <br /> that this Information I am providing will be relied upon by the County of Burnett Wiscon In in determining whether to Is- o i o <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett lying on this Information I am p <br /> providing in this application. I agree to permit county offlelals charged with administe Ing county ordinances or other 3 , i� <br /> authorized pereon to have access to the above described premises at any reasonable tim for the purpose of Inspection. r � ? m E <br /> ���JJJ ^�n � � i <br /> SIGN HERE�`;V Zt �i � ,�n,Q� �.. OC 1�� `n E E E <br /> FA <br /> N <br /> (slgnalure of owner or building eonVaotor (date) o <br /> ZONING ADMINISTRATOR c 11(Y� T C_-*I U GIG�L— , ? yy�� <br /> V �NNtnNNNtn m <br /> TOWNSHIP PERMITS MAYBE REQUIRED o In v, o p+ cn m o m <br /> $$ $ 000gofA <br />