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ON COMPUTER/SCANNEt <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator w - o 0 <br /> APPLICATION FOR LAND USE PERMITS <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work N <br /> described and located as shown herein. The undersigned agrees that all work shall be done in accor- 3 a <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. N �' <br /> m <br /> m O <br /> OWNER---' _Fa c cc I L TELEPHONE / b 7� 7� oCD <br /> HOME ADDRESS �] �� �d , _ otitE- G�fl <br /> EMERGENCY/FIRE NUMBER ROAD NAME �h RJ v y <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR \, ` '' e�+ ' r /1�i i nr o <br /> ��t VCVI 0 o <br /> TYPE OF PERMIT(S): DWELLING/BUILDING—GARAGE/ACCESSORY STRUCTURE ADDITION <br /> 0 <br /> 0 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION � <br /> o <br /> L I <br /> STRUCTURE/ADDITION USE: ^-' � � I e � S P <br /> (Home/Cabin; Commercial Business; Bedroom; Deck;etc.) <br /> 0 <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 /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> m -P Cf) <br /> n o a <br /> 1. All required dimensions or distances to be shown or drawn to scale. n �. <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate C y <br /> } <br /> North (N). -)Q, <br /> 3. Show dimensions in feet of the following: (a) building(s) to all lot lines, (b) building(s) to centerline of <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, S <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. � Cn <br /> m <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE A PERMIT CAN BE ISSUED. <br /> N <br /> 0 <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. <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 /> 6. <br /> o c w a f M <br /> 7. C — a,� ?. aC aCD M0 � �. : w � � 05. M <br /> CD L : '< � 0 (0 <br /> m0 `D� —1 <br /> Z � 0i T � : M <br /> 8. ° Cn ici 2 i i m <br /> � O <br /> o f a 0 C <br /> (D m <br /> 1 declare that this application (including any accompanying schedule) has been examined by me and to the best of my j m <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of �', <br /> 9 P 9 P Y cn w <br /> PP (including Yaccompanying ) g ocn o : <br /> all information contained in this application includin an schedule and I further declare that I recognize v 1 o :D o <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- o : o <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 p <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other B <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T N <br /> M <br /> cD <br /> SIGN HERE i rev <br /> (signature of owner or building contractor) (date) o <br /> 1 o E <br /> ZONING ADMINISTRATOR <br /> to<n En�cn rfl�» TI <br /> -+ N N Ui N N N Cn m <br /> TOWNSHIP PERMITS MAY BE REQUIRED o 0 0 0 0 0 0 0 m <br /> 00000000 <br /> 00000000 fA <br />