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E 1A <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d � o c <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> 0 <br /> 70 THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. o <br /> m m <br /> m m <br /> C <br /> OWNER + E-ANNC .M ` d yeE TELEPHONE �3�'- 3 ��g � £ <br /> �1 m � <br /> ADDRESS /992 SYRES Kd. SPOONE-P� �,/:r `^ <br /> EMERGENCY/FIRE NUMBER ROADNAME SYktS t <br /> LEGAL DESCRIPTION (seetaxreceipt) PcL Gov / OT I &OT /7) 510/4rLO/A14104 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE—)k— ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> O O <br /> / / N <br /> STRUCTURE/ADDITION USE: STORAC24C SHED OU6 0 R C7 <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z <br /> o <br /> a <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 (OF). <br /> 3. Show dimensions in feet ofthefollowing:(a) building to all lot lines,(b)building to center line of road,(c)building -q <br /> measurement to the ordinary high water mark of lake,stream,or river. 0 <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. 11 <br /> a y <br /> PLOT PLAN Zjell ca <br /> o a <br /> M _ N <br /> 0 <br /> C <br /> (A <br /> M <br /> I <br /> 13 <br /> i <br /> 0 <br /> s <br /> o <br /> N <br /> n <br /> Z <br /> S <br /> 1 <br /> D N (n � Nr- DDp 1] <br /> ODa 0M c m m o a m <br /> m <br /> CONDITIONS OF PERMIT: v A <� m C 0o <br /> o �_ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F a '2 ? i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. O n O <br /> $ n � M <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl <br /> edge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all informs- w m w <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infer- I <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 8 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- <br /> plication. I agree to permit county officials charged wit administering county ordinances or other authorized person to have O f� p <br /> access to the above de ribed premises at any reasotpble time for the purpose of inspection. <br /> m 3 A x <br /> q m A <br /> SIGN HERE <br /> N <br /> (signature of kwner oruil iRg ontr d (d e) �. [ <br /> ZONING ADMINISTRATOR o L I $ <br /> TOWNSHIPP MITS MAY BE REQUIRED »N N " <br /> N N N O N O O O m <br /> 88888888um) <br />