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ON COMPUTER/SCANNEDL'�JY'Yl�� <br /> Byrnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator o <br /> APPLICATION FOR LAND USE PERMITS o <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 I other - o <br /> applicable County Ordinances and the laws a regulations of the State of Wisconsin. H m <br /> c �? <br /> OWNER � TELEPHONE �i5- �3sa m <br /> HOME ADDRESS /�-S LJ 1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME H ! ( 1 <br /> LEGAL DESCRIPTION(see tax receipt) <br /> CONTRACTOR <br /> o - <br /> `� o <br /> TYPE OF PERMIT(S): DWELLIN UILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> 0 <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION- <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;C94mercial 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. m <br /> O <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O 3 <br /> T P N <br /> T O K <br /> 1. All required dimensions or distances to be shown or drawn to scale. m Z. <br /> 2. Show the location and size of all existing buildings(EB)and all new buildings (NB) and indicate m (Z <br /> North (N). ai ° <br /> 3. Show dimensions in feet of the following: (a) building(s)to all lot lines, (b) building(s)to centerlii ie of m <br /> road, (c) building(s) measurement to the ordinary high water mark(OHWM) of lake, stream or ri er. C <br /> 4. Show the location of the well (W), septic tank(ST)and drainfield (DF), and all distances to build ngs, <br /> roads, lake, lot lines. M <br /> 5. Indicate if a walkout basement is planned and show areas to be graded or filled. O <br /> 6. If separate plans are submitted by an architect, engineer, builder, contractor, etc., the plans mu t be t r <br /> signed and dated by the owner. N <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION E- ° <br /> FORE A PERMIT CAN BE ISSUED. <br /> N <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: o <br /> N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERM <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELI 4E. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY ( 9 <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN 75 FEET OF THE <br /> OHWM /OF LAKES, PON/DS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. S� I,n lc�Juci7rl y}�vPaS (r/ d&'kc, -o be S41me- AS <br /> 6. PerrryH-: 4:70nr- ,S (4>Q1 �g1yy S�J7Er�I I CSEP �'r/r l yg/ y o s <br /> �+y NNTJN DD 17 <br /> M o. c �. � �� m <br /> 7. a g.� Rao <br /> m N o Q ; <br /> 0 O <br /> 8. o - <br /> N �C m'V <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the be t of m '• - m <br /> PP ( 9 Y 1 Y Y <br /> knowledge and belief it Is true,correct and complete. I acknowledge that I am responsible for the detail and ace racy of f'„ 'mO <br /> all information contained in this application(including any accompanying schedule)and I further declare that Iognize i Pn o <br /> that this Information I am providing will be retied upon by the County of Burnett Wisconsin in determining whet r to is- <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Informs on I am O a:V`\ <br /> providing In this application. I agree to permit county officials charged with administering county ordinances r other [ 3 ; 2 <br /> authorized person to hqveaccess to the above descri p mises at ny reasonable time for the purpose of Ins action. m H E <br /> N <br /> �4 <br /> SIGN HERE <br /> Ignatu of owner or i aelltnCWr)_! 1—' <br /> ZONING ADMINISTRATOR . . <br /> 'JIMi N NfT NNNN <br /> O (nNOO, NNO m <br /> TOWNSHIP PERMIT,, AY BE REQUIRED_;r,. I O O o 0 o m <br /> - - - - <br />