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t7w i. lel l <br /> Burnett County 7410 Co. Rd. K, No. 102, Siron, WI 54872 Office of Zoning Administrator -01 o <br /> m : <br /> 5 � f <br /> APPLICATION FOR — LAND USE — PERMITS m <br /> 0 <br /> TO 1 HE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work descri and <br /> e <br /> w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of th $ <br /> Burnett County Land Use Ordinance,Sani[ffibn Code,and with all other applicable County Ordinances and the la and _ <br /> 0 <br /> regulations of the State of Wisconsin. a m <br /> m <br /> m � o <br /> OWNER TELEPHONE �'j l5� S`I <br /> ADDRESS �.C. lx7 �. � <br /> EMERGENCY/FIRE NUMBER 7 1 4✓ ROADNAME Grt,e� <br /> LEGAL DESCRIPTION (see tax receipt) Lt,4 6 0"al Slc,- P& -S <br /> CONTRACTOR e K 1 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a °- r-I-- <br /> w 0 w <br /> STRUCTUREIADDITION USE: reel\ )^ M o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o o <br /> 0 <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). I °- <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)I ullding <br /> measurement to the ordinary high water mark of lake,stream,or river. 0 7 <br /> - <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sigil ed and 9 <br /> dated by the owner. 0 <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE UED. 3 m <br /> 11 Z `o <br /> PLOT PLAN SFe, ti o a <br /> M o <br /> C S <br /> �I I9J <br /> I <br /> T N <br /> O <br /> 0 <br /> m iV <br /> O � <br /> r I� <br /> 2 <br /> tt <br /> 1 <br /> F, <br /> m <br /> CONDITIONS OF PERMIT: = m' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F �rn <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. �e m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best o my knowl- 9,�` o : , w h? � <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of II infonna- 8 $ , m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize th this infor- $ <br /> D <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 $ <br /> further accept ail liability which maybe a result of the County of Burnett relying on this information I am providin in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized per n to have v <br /> access to the above described premises at any reasonable time for the purpose of inspection. T . <br /> SIGN HERE �•-� �(0ate1 <br /> (sig uro plow or ding contractor) <br /> ZONING ADMINISTRATOR - <br /> TOWNSHIP PERMITS MAY BE REOUIR �/ o u�5 u m <br /> 8$ 888888w <br />