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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator C0 l 0' O o <br /> APPLICATION FOR LAND USE PERMITS i <br /> logw <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work y O <br /> described and located as shown herein. The undersigned agrees that all work shall be done in ccor- <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 /> OWNERI G TELEPHONE /- q x_55 g'o <br /> (f/ 7d mWV <br /> HOME ADDRESS <br /> S /U, Nit <br /> I I � - , 1UJC 3 <br /> EMERGENCY/FIRE NUMBER ROAD NAME w86 f-j�o,,�)Zk <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CONTRACTOR Se 4 <br /> o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURES ADDITION <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION v <br /> Z o <br /> STRUCTURE/ADDITION USE: L' �1)WU Z710 <br /> (Home) bin; Commercial Business; Bedroom;Deck;etc.) <br /> r <br /> 0 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE C R <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. In <br /> O <br /> z <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 3 <br /> n Z i <br /> 1. All required dimensions or distances to be shown or drawn to scale. o a <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings (NB)and indicate m <br /> North (N). to I <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. J r <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. D <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 <br /> signed and dated by the owner. <br /> Gn <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION E E- <br /> FORE A PERMIT CAN BE ISSUED. N S <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMI <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELI 4E. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY TU 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 /> N vivm DDO17 <br /> M on < O' a0- 11£ m <br /> m <br /> 7. = 2 N 0 0 0 <br /> 9 N O pk`2 : <br /> cFo Tom : m <br /> 8. 2 O <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the bet of my �i = <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of <br /> oo o : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- ' o : o <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 i n E o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 9 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> A N <br /> A <br /> SIGN HER <br /> gna re of owner or building contractor) (date) <br /> p : <br /> ZONING ADMINISTRATOR ` <br /> Q�NN(T N(n m <br /> TOWNSHIP PERMITS MAY BE REQUIRED Co 0 0 0 ' o o m <br /> o000 0:0 <br />