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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator w m a 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3_ <br /> d o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. y m <br /> O <br /> OWNER ]31LTELEPHONE L_ 4a[ _ �206 <br /> o <br /> U ''] m m <br /> ADDRESS S1' S- S.ST- PHIL MO, SSD (S <br /> EMERGENCY/FIRE NUMBER TROAD NAME _ <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> '^ r <br /> STRUCTURE/ADDITION USE: o ° <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z <br /> Oo <br /> v <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 (N and Indicate North (N). <br /> 2. Show the location of the well (W),septic tank (ST), and dreinfield (DF). I <br /> 3. Show dimensions In feet of the following:(a)building to all lot linWor,.etctthe <br /> ;e er line of road,(c)building <br /> measurement to the ordinary high water mark of lake,stream, or4. If separate plans are submitted by an architect, Ider, ust be signed and <br /> dated by the owner. ` C o <br /> NOTE. BUILDING/STRUCTURE L TI T ED FOR ONSITE VERIF I O A P CAN BE ISSUED. 7I v N <br /> PLOT PLAN n/ o a <br /> / <br /> i(L <br /> O <br /> ' <br /> ATT E� m Z' <br /> IN <br /> I Z <br /> I" <br /> m <br /> y � <br /> CONDITIONS OF PERMIT: v m g Q c g' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F L �� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N 2 m <br /> n <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- h y e+ m <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 o`$ <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— <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have N m <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> r a m mA0 <br /> SIGN HERE <br /> (signature of owner o ui mg tr t I D ( te) FI:: <br /> ` <br /> ZONING ADMINISTRATOR <br /> a(n��n`n,NNnv <br /> TOWNS PERMITS MAY BE REQUIRE N N N N N p <br /> $ $ SS € <br />