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onc��p <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator n z <br /> APPLICATION FOR - LAND USE - PERMITS �_ E <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work clesci ibed and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requireme its of the m ` <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all her applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. c . - _ <br /> i ��� � �"ill(�✓i1,CA% {�r,°, �/��7 /Qty o <br /> OWNER -71, <br /> � 1 , 11 !v J�%`:BELE l(F'/o��(D r7��OS m m <br /> / /J/�•1��� m� / TELEPHON ` eJ/ n O <br /> ADDRESS c�2 .8 M <br /> n <br /> EMERGENCY/FIRE NUMBER /)� ,._ L.�uRO ✓� ' <br /> l.! GL/XJ NAME <br /> LEGAL DESCRIPTION (see tax receipt)/t M r I O ,_4 <br /> CONTRACTOR /m O <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION <br /> 0 <br /> :. <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> o <br /> J <br /> E <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Coorerciel Busin s;Bedroom;Deck; etc.) Z m � - <br /> 0 0 <br /> 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). o <br /> 3. Show dimensions infest of thefollowing:(a)buildingto all lot lines,(b)buildingto center line of road,(c) building <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 sig ed and 0 b <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED, IN o3 m" <br /> PLOT PLAN 11 Z C <br /> o a <br /> j/CII�SQ �P2rz"�j�fCl�/Ctlt/r»� a <br /> M <br /> �> N <br /> 0 <br /> O <br /> 1 J <br /> O , <br /> J <br /> m <br /> O � <br /> y <br /> _ r <br /> J C ` <br /> z <br /> D <br /> ry <br /> J 1 <br /> II <br /> W c->> 0 -V <br /> 0 D�� p m Q m <br /> CONDITIONS OF PERMIT: c M <br /> < w:- c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m o <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P F rn J _m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. V7 gg 0 <br /> k ' <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of ml nowl- } g C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the tletail and accuracy of all i forma- -)' m «E <br /> tion contained in M19 application(including any accompanying schedule)and I further declare that I recognize that th s inlor- ��!': $ B g ? m <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to ie that <br /> a <br /> emit. 1 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in his ap- - 8 8 <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person o have <br /> access to the above described premises at any reasonable time for the purpose of ins ` a �' <br /> D Po inspection. m m . <br /> m : o <br /> SIGN HERE « '" <br /> (signature o owner or building contractor) (date) «- <br /> ZONING ADMINISTRATOR <br /> i F <br /> f i 8 i 2 <br /> r <br /> TOWNSHIP PERMITS MAY BE REQUIRED �`"'"' <br /> « «r' <br /> ... �o � � is� ryi�� m <br /> 888888'88 RD <br />