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Burnett County-7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Adminis rator w - o 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work y C� <br /> described and located as shown herein. The undersigned agrees that all work shall be done in Icor- m ` <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other 3 <br /> 0 <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> OWNER /rotokt 15 He- <br /> e TELEPHONE 612- 11V4 - 2 <br /> HOME ADDRESS <br /> C, jj Land a d m� . <br /> `/ s e GQ gig ST. SO K <br /> EMERGENCY/FIRE NUMBER S37S ROAD NAME 'fa 6or la kc b UG <br /> Lor t'/ rabor Lake-- Crow t Fttrk oP Crvcsva MeA <br /> LEGAL DESCRIPTION(see tax receipt) <br /> -0 41rE — S !Q c 4 � <br /> swiss <br /> CONTRACTOR <br /> - v o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION 0 <br /> W O <br /> X O ^ <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT_1—SUBDIVISION <br /> STRUCTURE/ADDITION USE: 5 l/ (. QQ <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) <br /> rn <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE CR _ <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. T <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0 3 <br /> -n 'P in <br /> T o n <br /> 1. All required dimensions or distances to be shown or drawn to scale. <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB) and indicate m ( N: <br /> North (N). to <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of m I <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 buildir gs, �_ n <br /> roads, lake, lot lines. ( \ <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. m <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION B.=- <br /> FORE <br /> -FORE A PERMIT CAN BE ISSUED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. , <br /> CONDITIONS OF PERMIT: R <br /> N <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 SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ? <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN 75 FEET OF I HE YJ <br /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. j <br /> 5. <br /> 6. <br /> in rn -ornrD Do -a <br /> 7. _. <br /> V < N 'TWO =O <br /> 8. o = <br /> v,: m <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the bes of my G) m <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accu acy of r',{dam„ D <br /> all information contained in this application(including any accompanying schedule)and I further declare that I rei ognize o o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining wheth r to Is- o . o <br /> o ; o : <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this informati n I am 0: o <br /> providing in this application. I agree to permit county officials charged with administering county ordinances o other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of insp ction. <br /> p <br /> �ac:l;f Ccor�l >�r I <br /> SIGN HERE <br /> clf� I i <br /> N00((No0pp0 : <br /> (31tur ofowneror I ngconta tor) (date) <br /> ZONING ADMINISTRATOR mb0 <br /> Nb0(No0permo0 <br /> m <br /> TOWNSHIP PERMITS MAY BE REQUIRED mOmNmOm fA <br />