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UN UU1i, PUTER/SC ANNE D <br />r <br />Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator <br />APPLICATION FOR — LAND USE — PERMITS <br />TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and <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 <br />regulations of the State of Wisconsin. <br />OWNER Flp R pSO d TELEPHONE <br />ADDRESS�[I j 5+h ST SMC LS,M NSSgIq'S- SE MC LS , M N • SST <br />EMERGENCY/FIRE NUMBER <br />LEGAL DESCRIPTION (see tax receipt) <br />CONTRACTOR <br />ROAD NAME <br />TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br />SANITARY y PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br />STRUCTURE/ADDITION USE: <br />(Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <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 the following: (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 <br />dated by the owner. <br />NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. <br />PLOT PLAN <br />WR O-i5p <br />CONDITIONS OF PERMIT: <br />1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 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 PERMITTED. <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. 1 acknowledge that I am responsible for the detail and accuracy of all informa- <br />tion contained in this application (including any accompanying schedule) and I further declare that I recognize that this infor- <br />mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <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 <br />access to the above described premises at any reasonable time for the purpose of inspection. <br />SIGN HERE <br />ZONING ADMINISTRATOR <br />TOWNSHIP PERMITS MAY BE REQUIRED <br />9-9-9q <br />(date) <br />cn"'Y9f <br />w <br />o <br />� <br />f <br />o <br />M <br />c <br />3 <br />� <br />N <br />»1 <br />C <br />M <br />a <br />v r <br />o� <br />in <br />1 <br />y.- <br />0 <br />a <br />o <_ <br />o ° <br />7 <br />Z o <br />o <br />0 <br />M <br />0 0 <br />IN a <br />� Z <br />n o <br />ftl <br />C <br />l <br />N <br />O <br />_7 <br />tC <br />v_ <br />N <br />A <br />) <br />