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ft C16)1 91 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator d T -- 0 <br /> APPLICATION FOR LAND USE PERMITS 3• — <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work T y <br /> CD <br /> described and located as shown herein. The undersigned agrees that all work shall be done in actor- 3 n O <br /> CD <br /> dance with the requirements of the Burnett County Land Use Ordinance,Sanitation Code,and with all other <br /> vDID <br /> applicable County Ordinances and the laws and regulations of the State of Wisconsin. °' o <br /> �i v £ <br /> OWNER es•% TELEPHONE � (<_ y�as� v m <br /> 7 •`" OQ <br /> HOME ADDRESS 3,3 �� ~h�T � �✓ �cGhrw ��/T S`yy>7 l <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION(see tax receipt)^ ,, 1.-,, Sec/2 <br /> CONTRACTORCD <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTUREADDITION <br /> y O <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a �-- <br /> Z v <br /> m <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) 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. 'n <br /> O <br /> A 2 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 03 <br /> r Z Q <br /> 1. All required dimensions or distances to be shown or drawn to scale. m o a <br /> 2. Show the location and size of all existing buildings (EB)and all new buildings(NB) and indicate o• <br /> North (N). m t 7 <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, <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. L `V CD <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BE- <br /> FORE A PERMIT CAN BE ISSUED. N2. <br /> — <br /> 0 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. <br /> CONDITIONS OF PERMIT: 0 <br /> C � <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 9 <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 w Da0 'p <br /> 7. Qm: o a <br /> 5. p c vCL� <br /> 'o n" <br /> Z f TCn <br /> 8. m <br /> o f CD C <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my w : m <br /> '• En� F»: O <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of cnm cn <br /> o : <br /> all information contained in this application(including any accompanying schedule)and 1 further declare that I recognize CD(o 6 ? 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 ; C: 0: <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> l0 N <br /> SIGN HEREo <br /> sig tura f owner-pr building contractor) (date) p <br /> ZONING ADMINISTRATOR <br /> - ro 0 NNpaEn m <br /> O f1NO Vt <br /> Ln (n0 <br /> TOWNSHIP PERMITS MAY BE RE4UIRED 00000 0 fp <br />