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en ate) <br /> Burnett Counttr 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator u m o 0 <br /> APPLICATION FOR LAND USE PERMITS w 3 <br /> z <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work � <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- 3 <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other - o <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. H w <br /> OWNER Stuart S Lloyd TELEPHONE <br /> 715-866-8689 o P� m <br /> v `�\V <br /> HOMEADDRESS 27389 E Connors Lk Rd - Webster Wi 54893 <br /> EMERGENCY/FIRE NUMBER 27389 ROAD NAME E Connors Lk Rd (� <br /> LEGAL DESCRIPTION(see tax receipt) Connors Lake Add - Lot 8 & 9 <br /> CONTRACTOR Self (7') <br /> o \\ I <br /> � o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION 0 <br /> N 0 <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION v <br /> 0 0 <br /> STRUCTURE/ADDITION USE: Deck - replacement <br /> (Home/Cabin; Commercial Business; Bedroom;Deck;etc.) <br /> r <br /> 0 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> 'n 7 u <br /> 1. All required dimensions or distances to be shown or drawn to scale. 5 o $ <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB)and indicate m <br /> North (N). C <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of m <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. O r <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildings, 0 <br /> roads, lake, lot lines. <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. _ <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be r <br /> signed and dated by the owner. v <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> S' <br /> 2. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <br /> N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ?O D <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> f <br /> 6. <br /> ur rnvm� Dpy <br /> 7. <br /> m <br /> D � way � . � <br /> Oa m O O 0 ; <br /> 8. <br /> m <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of O <br /> all Information contained in this application(Including any accompanying schedule)and I further declare that I recognize <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- e E e <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Information I am p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described promises at any reasonable time for the purpose of Inspection. <br /> SIGN HERE <br /> Pignet ire o owner or byi eontraotor) (date) <br /> $ E <br /> L <br /> ZONING ADMINISTRATOR <br /> N t N m <br /> TOWNSHIP PERM TS MAY BE REQUIRED o u, u, <br /> P9, u u o m <br /> SSBpSSSSw <br />