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�Gw` <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator Cr - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> � o <br /> TO THE TONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work m <br /> described and located as shown herein. The undersigned agrees that all work shall be done in a=or- <br /> dance with the requirements of the Burnett County Land Use Ordinance, Sanitation Code,and with all other o I�JT <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. <br /> OWNER TELEPHONE p m <br /> m ` 1r1 <br /> HOMEADDRESS /�' )5 3 � I a uv P, <br /> 7 <br /> EMERGENCY/FIRE NUMBER ROAD NAME i <br /> t <br /> LEGAL DESCRIPTION(see tax receipt) !); - N Ly E L Z Sw r S S Co. <br /> O <br /> CONTRACTOR <br /> �+ o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING-GARAGE/ACCESSORY STRUCTURE ADDITION � -^ <br /> N O <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> 0 0 <br /> i�Clq � / 3 <br /> STRUCTURE/ADDITION USE: O yet c L-9 S I ES 3 <br /> (Home/Cabin; Commercial Business;Bedroom; Deck;etc.) P o <br /> r <br /> 0 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE O <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n <br /> A o <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) p 3 <br /> T 3 m <br /> T Z c <br /> 1. All required dimensions or distances to be shown or drawn to scale. m ° a <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings (NB)and indicate o M <br /> North (N). (a <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 buildings, <br /> roads, lake, lot lines. fT y <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. 1 1 <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. SuN <br /> ig <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE <br /> -FORE A PERMIT CAN BE ISSUED. �} <br /> o <br /> CIO <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. 3 <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 E. <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 /> OHWM OF LAKES, PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. <br /> f <br /> 6. <br /> oc � � roDi $ f m <br /> 7. <br /> Q < <br /> 8. c- ���"" Civ -F S� m <br /> c m <br /> o : <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the bes ofm : <br /> M <br /> gid <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and acc racy of <br /> 00 0 : <br /> all information contained in this application(including any accompanying schedule)and I further declare that I roll nize o !^ o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whethi ir to is <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 r other ` 3 ' 8 <br /> authorized person to 4#9 access to the ab ve described premises at any reasonable time or the p,irpose of-inspx <br /> SIGN HERE Iii I <br /> N ; <br /> (einat re of own Ilding contractor) i ! Off ) <br /> I <br /> I1 O i i <br /> ZONING ADMINISTRATOR ' ' 1' '• <br /> N N N m <br /> TOWNSHIP P MITS MAY BE REQUIRED , _ 0 0 0 0 0 0 o m <br /> d <br /> 0000000N <br />