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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U C o ' o <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> m p <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the 3 <br /> Burnett County Land Use Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and _ <br /> regulations of the State of Wisconsin. w m <br /> c <br /> OWNER � '2 /1 TELEPHONE <br /> I O m <br /> m <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER f� ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> p��� <br /> CONTRACTOR <br /> �C?) <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o I <br /> n 17 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> /�/�) � r <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commerci I ass; Bedroom;Deck;etc.) Z o <br /> o 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top 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 drainfieid (DF). <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)buildingto center line of road,(c)building <br /> measurement to the ordinary high water mark of lakes 0 <br /> 4. If separate arc tect,engineer,builder,contractor,etc.,the plans must be—signed and 9 <br /> y the owner. C <br /> N TE: BUILDING/STRUCTURE LOCATO�N'> FSfFE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '11 o <br /> o n v <br /> Y C <br /> n <br /> �S hit oc, <br /> m <br /> o <br /> N <br /> � rn <br /> COND IO RMIT: v ? ' .2 c g <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o Q ' =1 <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. rqn m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- � qgg 1 C <br /> 3 >7 <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- � }��rr: m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- `: iS B <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I � ': g`$ g <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have ' <br /> access to the above described premises at any for the purpose of Inspection. <br /> it <br /> SIG MERE <br /> (ai u of Aner uilding contractor) <br /> ZONING ADMINISTRATOR N nn ° 8 <br /> TOWNSNIP PERMITS MAY BE REOUIR / i N«N ~M T <br /> ppR o � � tnN . B � m <br /> $ 8888 $ 8fn <br />