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Ofi <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator <br /> _ APPLICATION FOR LAND USE PERMITS <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work � y <br /> described and located as shown herein. The undersigned agrees that all work shall be done in accor- <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. H m <br /> OWNER £ n / TELEPHONE .. £ <br /> LcClc:/IRG� <br /> O _ <br /> HOME ADDRESS (� L <br /> a7(sgS /Y)l°Fleywnoo� L I kb,e g u e -Towq 5:Q00i � <br /> EMERGENCY/FIRE NUMBER x 9 9 2 3 ROAD NAMEC e p RP) r? ER p , qt, S <br /> L O T / L .rJ ^T <br /> LEGAL DESCRIPTION(see tax receipt) 13 G S X Z .'r R r9[. �I O T}1`/ZNTeR CSS/ Q uT <br /> CONTRACTOR je IU S PN iV//1 S O LA R ')( � C d W AR a /T ;f fp,4 L 0 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING A /ACCESSORY STRUCTURE ADDITION `' 0 o <br /> � r <br /> y O <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION USE: C ),lee) CFI/Z /T j�,r <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> r <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. T <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> -n 'P rn <br /> TZ <br /> 1. All required dimensions or distances to be shown or drawn to scale. 5 P <br /> 2. Show the location and size of all existing buildings (EB) and all new buildings(NB) and indicate a <br /> North (N). y <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerline of m <br /> road, (c) building(s) measurement to the ordinary high water mark (OHWM)of lake, stream or river. x <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. <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 l <br /> signed and dated by the owner. ` <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMI <br /> o <br /> N _ <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. a <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 /> rn rn -0 cn a M <br /> 7. g 33 FL g imp <br /> id <. <br /> N. 'gy m 0 m' 3 <br /> 8. <br /> m <br /> D <br /> C <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m °` m. m <br /> PP ( 9 Y ) Y Y <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of E ,r't m ,V O <br /> recognize o ! oall Information contained in this application(including an accompanyingschedule)and I further declare that I , <br /> g . <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Is- 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 3 ` 8 <br /> authorized 3 <br /> person to have access to the above described premises at any reasonable time for the purpose o}Inspection. <br /> SIGN HERE <br /> N ; <br /> ( bna ire of om r building a nt actor) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRE " " " P m <br />