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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator 0 m o <br /> APPLICATION FOR — LAND USE — PERMITS . <br /> 0 <br /> TO 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 them <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. <br /> OWNERp�tr . .} � <br /> £TELEPHONE .g`,0t, ZAO <br /> ADDRESS (�/1,l( Z <br /> „— <br /> EMERGENCY/FIRE NUMBER ROADNAME <br /> LEGAL DESCRIPTION (see tax receipt) - rpt <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE�_ ADDITION �- <br /> 0 <br /> SANITARY <br /> PRIVY FILLING/GRADINGC MPING UNIT SUBDIVISION 0 <br /> o < <br /> 18b0 !sa <br /> m <br /> STRUCTURE/ADDITION USE: 0 0 <br /> (Home/Cabin;Com ercial siness; Be oom; Deck;eta•) <br /> Z o <br /> o � <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 (DF). o <br /> 3. Show dimensions in feet of the following: (a) building to all lot lines,(b)building to center line of road,(c)building -1 <br /> measurement to the ordinary high water mark of lake, stream,or river. <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 <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. o w <br /> PLOT PLAN 44 z `o <br /> M o <br /> I J <br /> f ,s L-or *' l3 i <br /> 60or. Lo Sr Sc'.n OrJ 44 14 c <br /> JI Lw.r oFJa-NLSB..1 <br /> f ° �� a�tT Ces ✓•tet-1 tnJI=- <br /> 0.Z <br /> o < <br /> 10L6 4 <br /> suet. � <br /> !s , Asnr — p�eC�L of, rpm,f165 <br /> amindf 'r d <br /> i <br /> kvI <br /> r 7 m o c ry m o D f m 0 <br /> CONDITIONS OF PERMIT: ¢ v m < in o ic <br /> S. N : N o J fp <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F T' i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - N m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Vi G) 2 O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowlo a <br /> edge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all informs- m,« 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 a permit. I 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 with administering county ordinances or other authorized person to have N <br /> access to the above described premises at any reasonable time for the purpose of inspection. im <br /> In <br /> 3 <br /> SIGN HERE <br /> N : : <br /> (signature of owner or building contr ort (date) v : x <br /> o ; <br /> ZONING ADMINISTRATOR n n r.M -11-IN <br /> $ <br /> TOWNSHIP PERMITS MAY BE REQUIRED m <br /> I <br /> SP 2 81992 <br /> $ 888 N <br />