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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator (m o I� o <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes m — o <br /> g hereby 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 c <br /> of the M <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. y m <br /> m m <br /> ��OWNER / ///J m <br /> �Dlf TELEPHONE <br /> ADDRESS �i/�. <br /> Ijr <br /> rl V <br /> EMERGENCY/FIRE NUMBER Ste`-TLS S 2Q +1 Gl ROAD NAAE p �r�.l `n <br /> LEGAL DESCRIPTION (see tax receipt) 40 <br /> C Rem 'T VId ' OF <br /> OF �`Al � 9SIT- <br /> V , <br /> CONTRACTOR �a� p — / �/ yl _ �/ ( ^ )' PCI <br /> j NI_.. . .', _ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING '-rGAA/RA(GEE/ACCEESSSIOORRYLSTRUCTURE ADDITION W p <br /> n L1 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> STRUCTURE/ADDITION USE: G- Fi'2j—J/-9n A/.( Oft �-1 tj IAI C) 7t o <br /> ome/Cabin;C mercia siness;bedroom; Deck;etc.) Z o <br /> I0 0 <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 infeet of the following:(a) building to all lot lines,(b)buildingto center line of road,(c)building -q <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 M <br /> dated by the owner. O o <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on 3 m <br /> PLOT PLAN o- n <br /> t3eOFFI-E <br /> 0 ¢— <br /> Oer�t I <br /> m <br /> 2o�cuo -� <br /> 84ii'wlte � BS 1 <br /> m <br /> 1 17&k <br /> N <br /> I S <br /> �d ACK�S <br /> o c m ro F m <br /> M — FLS ,may 0. � `= a <br /> CONDITIONS OF PERMIT: C o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F M : ? 5 <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.' <br /> g <br /> 2 � C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs. w m w O <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 $ m $ . <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- e' <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O N p <br /> access to the above described premises at any reasonable time for the purpose of inspection. m $ `� <br /> In 3 A x <br /> M N A m <br /> t A <br /> SIGN HERE � m $ <br /> (si n of er or bu contractor) (date <br /> V ,Z " <br /> O : <br /> ZONING A INISTRATOR 0_ $ <br /> TOWNSHIP PERMITS MAY BE REOUIRED H N N + N r <br /> _o <nrno <noo . m <br /> $ $ $ $ $ $ $ $ m <br />