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n-i) (W).p <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d A o 0 <br /> APPLICATION FOR - LAND USE - PERMITS3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and y <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. 2 m <br /> w <br /> C <br /> OWNER dames Skog TELEPHONE 715-349-5746 a <br /> v <br /> m m <br /> ADDRESS 6783 Lakeview Rd Siren WI 54872 m <br /> EMERGENCY/FIRE NUMBER 6783 ROAD NAME Lake view Rd I� <br /> LEGAL DESCRIPTION (see tax receipt) SW'/4SW'/4SEA S34 T39N R16W <br /> CONTRACTOR Donald Daniels <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> - I <br /> n O <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNIT_ SUBDIVISION o 0 <br /> STRUCTURE/ADDITION USE: o ° <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z9 <br /> o ° <br /> v <br /> m <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 drainfield (DF). <br /> 3. Show dimensions infest of thefollowing:(a)building to all lot lines,(b)buildingto center line of road,(c)building q <br /> measurement to the ordinary high water mark of lake,stream, or river. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 a rn]C <br /> c <br /> PLOT PLAN o nx <br /> See attached C 1 <br /> N � <br /> t � <br /> a <br /> I 0 <br /> o <br /> n/11 <br /> N <br /> O <br /> J <br /> O �� <br /> ti 1 <br /> Z <br /> c< w N a a 0 m <br /> A D <br /> N <br /> CONDITIONS OF PERMIT: v <2..: Z co: .005 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o Fo . <br /> :1� - <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - =T <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o 25 o : m <br /> o : ao <br /> 10 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- ^; m m : C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- i m a: m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. a <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o� 0- <br /> further accept all liability which may be a result of the County of Burnett 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 person to have O N 0- <br /> access to the above described premises at any reasonable time for the purpose of inspection. m ; 3 op <br /> p <br /> m A N <br /> 8/16/93 '" `- " 0 : <br /> SIGN HERE w v, $ <br /> (signature of owner or building contractor) (date) '. <br /> O : xE <br /> ZONING ADMINISTRATOR \�I(l1 1-�la(11Gfo�f1 I <br /> TOWNSHIP PERMITS MAY BE REOUIRED - 8 N m <br /> 000 000 fN <br />