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(S"n ' v" X I <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o a <br /> APPLICATION FOR - LAND USE - PERMITS 3. <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and c m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 l <br /> regulations of the State of Wisconsin. p _ o <br /> C <br /> OWNER S TELEPHONE £O <br /> TM O TO "f C.4N L_ n ieNY 316 G&S '✓orf _y <br /> ADDRESS -� 33 3 a��a''11uo -1kC� W 7 C N t rg r V S a d <br /> EMERGENCY/FIRE NUMBER 1 �15�f ROAD NAME t.�.u'Y 3 S' _ 0 A%V z— <br /> m / v <br /> LEGAL DESCRIPTION (see tax receipt) N'I I _ �/_ (�0—I� <br /> S v <br /> CONTRACTOR Iz L� w <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION ✓ p <br /> n L7 <br /> SANITARY PRIVY FILLING/GRADING CAMP G UNIT SUBDIVISION <br /> o < <br /> / N <br /> STRUCTURE/ADDITION USEo'cl-ea"e.- o' <br /> (Home/Cabin;Commercial Business;Bedro ; Deck;etc.) z S <br /> o <br /> v <br /> m <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). <br /> 3. Show dimensions in feet of thefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building <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 9 <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSRE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1111 c N <br /> PLOT PLAN l el o <br /> � a <br /> c '( <br /> :3s— C o <br /> : <br /> 1► <br /> 5 ( <br /> o <br /> P -p <br /> y...- <br /> 1� L � <br /> S <br /> � <br /> ,ra <br /> �yyL11V-(Z' <br /> z <br /> f <br /> 5 -g� '- n e'm m <br /> e= S1 <br /> CONDITIONS OF PERMIT: a m'<_. 5 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o f O ? T? -{ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. : = y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N: O i m <br /> o : a o <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- _j a m <br /> : m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- �J of : p <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 o'$ <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 a aO N p <br /> access to the above described premises at any reasonable time for the purpose of inspection. : mom <br /> _ m 3 <br /> SIGN HERE -- h <br /> si at re of own building tractor) d 1r_. <br /> � ' sE <br /> P : <br /> ZONING ADMINISTRATOR n B ? E <br /> Nw to 'n <br /> TOWNSNI PERMITS MAY BE REOUIRED o NT N N N p N m <br /> _ 0000 S 060 m <br /> LL- 0000 0000 <br />