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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator N o 0 <br /> APPLICATION FOR LAND USE PERMITS . <br /> z s <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. w <br /> OWNER [ ,Jnr I L� TELEPHONE 7- 15 �bw- <br /> m <br /> Of M <br /> HOME ADDRESS ,ll � Y C// / n L,. I (-bEMERGENCY/FIRE NUMBER /a O v ROAD NAME I��C'S /�� <br /> 301 0'I V 35 7 1(P1 b1y5.1 <br /> LEGAL DESCRIPTION(see tax receipt) Sd'd T k I•/W Acres 3 3eo <br /> II a- -lr�-/Y. 3a' nOC3o L s £ .5W <br /> CONTRACTOR nr-yl Ile Nares A- _Ihel I <br /> ILbbe1 Z6, ceO <br /> 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION <br /> N O <br /> O .. <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT <br /> SUBDIVISION— <br /> STRUCTURE/ADDITION <br /> SUBDI�VISIOGN <br /> STRUCTUREIADDITION USEm / � GL OSSr./ c � <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) / <br /> iCb.. ii <br /> C� <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. T <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> T "P m <br /> TZ <br /> 1. All required dimensions or distances to be shown or drawn to scale. o <br /> 2. Show the location and size of all existing buildings(EB)and all new buildings (NB)and indicate m y: <br /> North (N). y o <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. <br /> 4. Show the location of the well (W), septic tank (ST)and drainfield (DF), and all distances to buildings, <br /> s <br /> roads, lake, lot lines. I <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. m <br /> i4 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- ° <br /> FORE A PERMIT CAN BE ISSUED. (� j <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. F�— <br /> CONDITIONS OF PERMIT: <br /> o <br /> N_ rr11 '' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT n W <br /> ISSUANCE. OQ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ? <br /> PERMITTED. p <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF THE I` <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. {{\ <br /> 5. <br /> f <br /> 6. <br /> nM �(nr D a <br /> 7. m <br /> 0 �Z <br /> 6. <br /> V� 2 m <br /> S D <br /> o m <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my <br /> In <br /> knowledge and belief it Is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of <br /> all Information contained in this application(Including any accompanying schedule)and I further declare that I recognize 0 0 <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to is- <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 O p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 ig <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of I apectlon. <br /> H <br /> SIGN HERE <br /> gn!atu'rs of owner orbuildingcontractor) date) <br /> ZONING ADMINISTRATOR <br /> Fw Fn Fn -n <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> NfI� <br /> N N N N N N m <br /> OfrINO (T P O <br /> 00000000rJ� <br />