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Burnett County Y410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator cn m _-- 0 <br /> APPLICATION FOR LAND USE PERMITS 5 3 <br /> 12 <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work y <br /> described and located as shown herein. The undersigned agrees that all work shall be done in accor- m <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other 3 0 <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> OWNER <br /> TELEPHONE p m' <br /> J �7Df2� <br /> HOME ADDRESS m ' <br /> , t09,V_L X ff/IM B6,9 'LAKE, ni/V SS-/JC = -� <br /> Ofd' <br /> EMERGENCY/ IRE NUMBER 3 M 1A ROAD NAME".�0/8 'qx'Cs �(J <br /> -rill f</5-&) -SoOLAT ©F LfIKE c2 &I 62T -� <br /> LEGAL DESCRIPTION (see tax receipt) eoe ap T 14'7- j/0 0,0/yt rho n) <br /> Ff �O/hJ-1�7Uf.2�/A'6&sit, <br /> CONTRACTOR (rT/01i7 1J s2i trTa 2 <br /> �k �p ci m <br /> a < 1 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION N <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> z o <br /> OVA lS A,bA/riov 49,n) Sa. .5/LP)EQ ° CD <br /> STRUCTURE/ADDITION USE: SCIQ 1)6d-K IdL&S< r,&Arr <br /> J( /(JELJ �OO� <br /> (Home/Cabin;Commercial Business; Bedroom; Deck; etc.) <br /> o_ <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) 0 3 <br /> -n v c <br /> 21 Z Q <br /> 1. All required dimensions or distances to be shown or drawn to scale. m o a- <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB) and indicate y <br /> c <br /> North (N). m <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. I 1 (?! <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildings, (�- <br /> roads, lake, lot lines. Q <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. 0 <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be I <br /> signed and dated by the owner. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE A PERMIT CAN BE ISSUED. N <br /> 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. c <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. (�- -t-- <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY 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 /> 6. <br /> rn rn -ornDDa £ -a <br /> o, c �.w lv2a m <br /> fR O <br /> D <br /> CD O <br /> Z „• rn: : M <br /> 8. <br /> P <br /> v,? m <br /> u : 622 O <br /> o CLC <br /> o CD <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my m <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of 6MQCD a <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- g i0 <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 n o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T o '; y E <br /> [ N t <br /> 0 <br /> • N ; <br /> (signatureQf own buil contractor) (date) ': o <br /> R `n viifl�'F»s»cn�' �1 <br /> � N NU1NNNfT m <br /> TOWNSHIP PERMITS MAY BE REQUIRED o0 0 0 0 0 0 o m <br /> 0000o00oN <br />