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091 ct <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator w o <br /> APPLICATION FOR LAND USE PERMITS 3. n <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work UUF <br /> U <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- 3 � <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. CD <br /> y m <br /> OWNER ' TELEPHONE <br /> ll ,,rr QQ <br /> HOME ADDRESS � n R t cQ Ged< 91 V(� 1�,� I� (J <br /> G1 <br /> n _ <br /> EMERGENCY/FIRE NUMBER " �� ROADNAME ptq/J/S <br /> LEGAL DESCRIPTION(see tax receipt) <br /> 00 <br /> CONTRACTOR <br /> CONTRACTOR B�.) n ��e <br /> F-� v C� <br /> m G) . <br /> TYPE OF PERMIT(S):DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION 0 < <br /> m .0.. <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> 0 0 �• <br /> STRUCTURE/ADDITION USE: PA-/-- / &i-Ch <br /> (Home/Cabin; Commercial Business;Bedroom;Deck;etc.) <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. .n <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> O 3 <br /> n 'O rn <br /> 1. All required dimensions or distances to be shown or drawn to scale. n o a <br /> 2. Show the location and size of all existing buildings(EB)and all new buildings(NB)and indicate m S. <br /> o <br /> North (N). y l <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of m W `t 1 <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM)of lake, stream or river. 1 <br /> 4. Show the location of the well (W), septic tank(ST) and drainfield (DF), and all distances to buildings, I � <br /> roads, lake, lot lines. V) <br /> I <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. C M <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans must be 0 <br /> signed and dated by the owner. Cn <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. 2. <br /> CONDITIONS OF PERMIT: o <br /> N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. vV <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 THE <br /> 5. OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 6. (r 9 l � <br /> vV /J <br /> /""` /.,f 1an co v Cn 0 D v <br /> /d rG/rl a�`� m m a : " c N o <br /> <. N. : `� W OP-Q O r0 3 <br /> A . . m <br /> ow' O <br /> QE CC <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my w i m <br /> knowledge and belief It is true,correct and complete. 1 acknowledge that I am responsible for the detail and accuracy ofp <br /> all information contained in this application(Including any accompanying schedule)and 1 further declare that I recognize ' 02 o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to i E gm E g E <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 0: p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other 3 ` 8 <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of Inspection. <br /> SIGN HERE 1, FJ,J rN <br /> Glyn ur ow or b r, (date) E 0 : i <br /> ZONING ADMINISTRATOR Fin <br /> i E E <br /> ' � '� � to to j'vi to Fn �I <br /> TOWNSHIP PERMITS MAY BE REQUIRED j J'3 ' N N U N N N P m <br /> ,,,,� OO1N001 ro (J1 O <br /> Oggggggfn <br />