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Burnett County 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administrator m <br /> APPLICATION FOR — LAND USE — PERMITS - — <br /> m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v v <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the a c <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and _ 6 <br /> regulations of the State of Wisconsin. w m <br /> c <br /> OWNER TELEPHONE Gia_ ggy_ p� 7r G m0 <br /> 7 <br /> ADDRESS I t�600 QlGnS µ ('Ck Yj 7# 10 dS/C rm",�fO.�j <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> fib1C& <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n 0 11 <br /> SANITARY PRIVY_ FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> o` < <br /> w � <br /> STRUCTURE/ADDITION USE: ° g <br /> (Home/Cabin;Co martial Business;Bedroom;Deck;etc.) o 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) a <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). a <br /> 3. Show dimensions In feet of thefollowing:(a)building to all lot lines,(b)building to 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 signed end <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1A o N <br /> q / /� 1A z o <br /> ]�G 0.� <br /> PLOT PLAN ° <br /> ll ' O <br /> a r <br /> 3� m <br /> aoe� <br /> v � <br /> 70' 30 <br /> m <br /> aJ(Zarhe = <br /> 0 <br /> Sn <br /> l <br /> V Z <br /> R. <br /> g� -'a <br /> CONDITIONS OF PERMIT: v : c g g N's E <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. p �j <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. i ru '• 9 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �^ ' ' Q i ; m0 <br /> QQ �Ei <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- m <br /> tion contained in this application(including any accompanying schedule)and 1 further declare that I recognize that this infor- $ O <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 $ $ <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.1 agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described promises at any reasonable time for the purpose of inspection. m <br /> xzet�� <br /> SIGN HERE <br /> (signature oftractor) (dat <br /> ewner or building cone) <br /> ZONING ADMINISTRATOR _f g ` ' '• <br /> TOWNSHIP PERMITS MAY BE REQUIRED 09' 4K Qt N'�5 rn <br /> m <br /> 888888',$8 in <br />