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Burnett County 7410 Co. Rd. K, No. 102, Sinn, WI 54072 Office of Zoning Administrator / f O o <br /> APPLICATION FOR - LAND USE - PERMITS ' - <br /> ° <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes appiication for a Permit for the work described and a v <br /> located as shown herein. The undersigneci agrees that all work shall be done in accordance with the requirements of the $ <br /> Burnett County Lard Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and _ <br /> regulations of the State of Wisconsin. s m U <br /> o <br /> TELEPHONE $ O <br /> OWNER <br /> �g✓RaRu6N �3s 8sa� m <br /> ADDRESS /� <br /> 139Y <�,C LAKE RxJ �SfOD/f/E� cu. 5Z/X0r � <br /> EMERGENCY/FIRE NUMBER139y, ROADNAME_6,,K LAKE 2O <br /> LEGAL DESCRIPTION (see tax receipt) L <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE ADDITION o <br /> ct <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> W I\LXIY— �V� o < <br /> nn a � <br /> STRUCTURE/ADDITION USE: 0D ° (2) <br /> (me Cabin;Commercial Busine s;Bedroom;Deck;etc.) Z o <br /> a a <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 drainf laid (D17. <br /> 3. Show dimensions In feet ofthe following:(a)building to all lot lines,(b)building to center line of road,(c)building I — <br /> measurement to the ordinary high water mark of lake,stream,or river. 0 <br /> 4. if separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed end 9 <br /> dated by the owner. O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. o rn <br /> 2 v <br /> PLOT PLAN ° o <br /> 5 In <br /> C <br /> 1 lQJ <br /> 4 0 <br /> V J N <br /> Lo <br /> UJ <br /> ,y V <br /> \ Z <br /> C, <br /> 1 <br /> R T2�aIj.I <br /> fi� 2. e <br /> CONDITIONS OF PERMIT: C r6 g A E <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. a I.R <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. E c Ng - '• M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r" i G7 m <br /> Er <br /> h ? <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all Informs. e+ m <br /> tion contained in this application(Including any accompanying schedule)and I further declare that 1 recognize that this infor- <br /> mation I am providing will be rolled upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I $ $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing In this ap- ' <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized person to have - <br /> access to the above described premises at any reasonable time for the purpose of Inspection. m <br /> SIGN HERE` /v.Jiaie U.JC2 (.Q.[/1R n!'Bi,.-ri1_ = E <br /> (sign of owner u Ing contractor) %i (date) j <br /> $ <br /> ZONING ADMINISTRATOR 6 i ' ' `• <br /> w �NN +' -n <br /> TOWNSHIP PERMITS MAY BE REOUIRED o 9'9 R N 511 m <br /> —'` 1888888'188 ami <br />