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0)1 cam) ' <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,W154872 Office of Zoning Administrator on M 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3' - <br /> 0 <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 c — <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. y m <br /> � v <br /> OWNER TELEPHONE <br /> HOME ADDRESS /{ /�S m�m br, <br /> _ I"I !lIJJJ III fvnn /� I <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt) s�A <br /> 1 � <br /> CONTRACTOR t� ���� _ (\M In f. ) <br /> I ` A o IL <br /> - o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION <br /> N <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> o <br /> STRUCTURE/ADDITION USE' ,. ��ILh V D .%(� `�I ' I V• �� � '�� ��IO <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <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. m <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> T 'P v <br /> T Z a <br /> 1. All required dimensions or distances to be shown or drawn to scale. m o a <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB)and indicate m SCJ o <br /> North (N). m <br /> 3. Show dimensions in feet of the following: (a) building(s) to all lot lines, (b) building(s)to centerline of I I <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM) of lake, stream or river. a' <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to buildings, o ( (� <br /> roads, lake, lot lines. <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. O <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 /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE A PERMIT CAN BE ISSUED. <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 PERMIT <br /> ISSUANCE. ) <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. r <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ✓�J n <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(n� mrDDO y <br /> M In <br /> 7. <br /> Z Fes ; TN ; M <br /> o - m <br /> ji 8. <br /> R : m <br /> o <br /> I declare that this application (Including any accompanying schedule) has been examined by me and to the best of my 1ii <br /> dmd m <br /> knowledge and belief it is true, correct and complete. I acknowledge that I 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 i : o o <br /> o , o : <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 <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 `� <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. <br /> w <br /> H <br /> SIGN HERE N[ E <br /> (signature of owner or building contractor) (data) o <br /> ZONING ADMINISTRATOR 1 1✓Y� I ICS/ 1 1�/V�✓1 i i E E i i <br /> t�f»v+�wFn f»� '71 <br /> N N t n N N N NIn <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 o o ao o In <br /> 0 0 0 $ o 0 0 o N <br />