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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator V '1 o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes m <br /> 9 by application for a Permit for the work described and m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the e CO <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. — o <br /> N d <br /> c <br /> OWNER <br /> C c <br /> S p D� � � (`v J TELEPHONE <br /> (� d <br /> ADDRESS � Q 2/ 4 s, r\, NCk too ORA;41&1 1 WS '1*3 O LVl <br /> EMERGENCY/FIRE NUMBER ROAD NAMER.V(k (k QA1 <br /> LEGAL DESCRIPTION (seetaxieceipt) <br /> J t (('1,), r�+i th ( F w (�! <br /> CONTRACTOR / J w'J'S{� <br /> SeC P 10 /.� <br /> ANSoN CM n$eP, )OPKINS s4• of t yflquet cv. I(te_ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING_7X__ GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> SANITARY PRIVY FILLINGlGRADINGCAMPING UNIT SUBDIVISION ° <br /> 0 o0 <br /> — <br /> u � <br /> STRUCTURE/ADDITION USE: Q M e- 0 0 <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z <br /> 0 0 <br /> a <br /> a <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. o <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. O 0 a y <br /> PLOT PLAN C It cc <; c S ;ve+L R D 11 Z c <br /> o a <br /> f7 < <br /> �! a) QUI Jc <br /> C <br /> Aft .. t M <br /> O <br /> uoule__ <br /> Re.,a e <br /> 7Ack Qua 2..r LL ruy'K � CA m <br /> tri Q e g`z <br /> V L ° <br /> For p.og,ttao„sc a � <br /> 0.e..+ovat Br.:.0 o <br /> o d o <br /> WkLC P- t <br /> SR <br /> or QtoPeit, I P s1 <br /> scvvck pip't btop. LS Z <br /> To <br /> O .se ,";L( /�4vG p e J z <br /> 09 0 0 — OAK Pr�pt 4j <br /> Fta T fko%c----- OCC tC fro '10 ke T0.ety L;a� <br /> CL,7gscy� l,Jk+ R P` <br /> L,we o� eR o,v2 <br /> CL*m Ri,Jall Plp,*-j st. <br />:o.,wtr LRuf1 to a dsf- --lq <br /> ANA Zf Jon..'IL #4'111 p <br /> CONDITIONS OF P�RMIT: N Cbe) e_ 7o QtcPcl+T' L, -4L o• a� m' C N o ?. 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 5. . ? T� ? i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED'ALONG SHORELINE. _ »" m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ' L7 O <br /> 'm g . G <br /> �. <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.I acknowledge that I am responsible for the detail and accuracy of all inform'- " I w m w O <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- m N <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ m $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in thisap- w <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have I O N O <br /> access to the a e des ibed premises at any reasonable time for the purpose of inspection. 0 8 8 <br /> T <br /> N �A <br /> N O <br /> SIGN HERE <br /> (si ria ur wrier or 'I g contractor) -- - <br /> � � r o x <br /> ZONING ADMINISTRATOR <br /> OWNSHIP PERMITS MAY BE REOUIRED <br /> 0 I� `IJUL 3 0 1992 <br /> N��/G/ /��� t� 88888888rn <br /> Q <br /> c <br />