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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m o c <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> d o <br /> TO THE20NING 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 m Cc <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. <br /> OWNER TELEPHONE L{ E <br /> ADDRESS �-�._ `/"I`��� J m ' m(�, <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> 1 � <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR D <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n o0 <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION o` <br /> STRUCTURE/ADDITION USE: o ^ <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> 0 0 <br /> D <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 dralnfield (DF). <br /> 3. Show dimensions in feet ofthefollowing:(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. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I o N <br /> 'll Z cQ <br /> PLOT PLAN 9 <br /> M o <br /> *ochcr <br /> U eCn <br /> — � <br /> N <br /> 0 <br /> 0 <br /> o � <br /> o <br /> m <br /> CONDITIONS OF PERMIT: 5, R, o 3 ro <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. = r^ ! m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. g'r' m C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o mm <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- Fw m N O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue permit. <br /> a 1 $ m $ <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- N <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 reasonable time for the purpose of inspection. <br /> 3 $ <br /> x <br /> 0 8 M N <br /> SIGN HERE e, <br /> (signature'of o r or b Iding cco�n�trector) (date) o ; x <br /> ZONING ADMINISTRATOR �I t� <br /> TOWNSHIP PERMITS MAY BE REOUIRED <br /> N N O N 0 0 0 m <br /> 88888 $ $ $ <br />