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Inn comp, <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator a A o O <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and �2 y <br /> ° J <br /> located as shown herein. The un ersigned agrees that all work shall be done in accordance with the requirements of the m a <br /> Burnett County Land Use Ordinar ice,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wiscor sin. - V <br /> OWNER L L_,C PARTELEPHONE '3-74 , 9737 o. � <br /> o <br /> ��..{{ <br /> ADDRESS 3�3C�I Jr• <br /> EMERGENCY/FIRE NUMBER ROAD NAME , <br /> 00 <br /> LEGAL DESCRIPTION (see tax recei t) -� <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/B ILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> o < <br /> r <br /> STRUCTURE/ADDITION USE: o <br /> ( ome/Cabin;Commercial Business; Bedroom;Deck;etc.) Z 0 <br /> O ° <br /> a <br /> m <br /> a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) ` <br /> 1. Show the location and size f all existing buildings (EB) and all new buildings (NB) and indicate North (N). s <br /> 2. Show the location of the we I (W),septic tank (ST), and drainfield (DIF). <br /> 3. Show dimensions In feet oft following:(a) building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordinaq high water mark of lake,stream, or river. 0 <br /> 4. If separate plans are submitt d by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCAFIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a y <br /> PLOT PLAN _ <br /> A � a <br /> fn 0 � <br /> AT Ac.14�b w <br /> m <br /> o <br /> I2 <br /> ° <br /> 0 <br /> N l�^ <br /> O / 11 <br /> N <br /> y <br /> Z <br /> ab <br /> V <br /> A O c Ci w 0 a <br /> mq cm M <br /> CONDITIONS OF PERMIT: <br /> 9 m :5.: C O O 05 <br /> 1. DRIVEWAY MUST MEET DR VEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 5 �Q iw <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N o: M <br /> 3. NO GRADING OR SHOREU ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o ° � ' D <br /> o : ig <br /> 1 declare that this application(ini luding any accompanying schedule)has been examined by me and to the best of my knowl io: C <br /> edge and belief it is true,correct 3nd complete.I acknowledge that I am responsible for the detail and accuracy of all informs- m <br /> tion contained in this application (including any accompanying schedule)and I further declare that I recognize that this infor- O,: v 8 a 9 p <br /> mation I am providing will be re led upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <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. r d, <br /> plication.I agree to permit count 1 officials charged with administering county ordinances or other authorized person to have O N p <br /> access to the above described premises at any reasonable time for the purpose of inspection. T 3 0 <br /> N w o <br /> SIGN HERE 1 q� <br /> 1214 at...of ba .0 seniFeeler) (date) <br /> ZONING ADMINISTRATOR �C"`• g ? x x :x <br /> TOWNSHIP PERMITS MAY BE REQUIRED o " � N§' m <br /> 00ob o ' m <br /> 000,00'0" $r`rA <br /> v x x <br /> 0 <br />