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At 6('" <br /> Burnett County 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administrator (tA g f oz <br /> APPLICATION FOR — LAND USE — PERMITS ' <br /> a s <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � a <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the $ J <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and _ <br /> regulations of the State of Wisconsin. m <br /> C g <br /> -� <br /> E <br /> TELEPHONE c A 7/ J G 35 - <br /> 7 Y7_7 p <br /> ADDRESS a` b0 (f /!I rIt &/-2d- s�oo,r/r:,fi WI rY�d o \ <br /> EMERGENCY/FIRE NUMBER d l0 6 G({ ROAD NAME <br /> ?e-pc rN <br /> LEGAL DESCRIPTION (seetaxreceipt) <br /> /o- 3Y ,U /k/ uJ. pCLS Fiov. Lo'T S .37s)/SY/ <br /> n <br /> CONTRACTOR PE(Z L r L K - /�eVe- L rc.x (:0.0 S! UG Ti oma✓ 11TI 1 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE X ADDITION o <br /> 0o Q <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION C. <br /> STRUCTURE/ADDITION USE: 6;-.f 4 A CC B(0 ri• <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) o 0 <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 (NB) and Indicate North (N). <br /> 2. Show the location of the well (W),septic tank (ST), and dralnfield (DF). a <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building -4 <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 and 9 <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSFE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 111 o m <br /> 11 Z a <br /> PLOT PLAN <br /> 5 a,• t- �s i In S ' o <br /> t i <br /> k 1)F C <br /> N f( <br /> �j <br /> ar R <br /> Er <br /> r <br /> o <br /> 0 <br /> b <br /> �_. UN <br /> Al <br /> 1 <br /> 1 <br /> y <br /> CL <br /> or <br /> CONDITIONS O PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. p I : 8'2 <br /> E '� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ? . E m <br /> E <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. E <br /> ; O <br /> 8i C <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowl- j <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 In <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. R p <br /> matlon I am providing will be rolled upon by the County of Burnett Wisconsin in determining whether to issue a permit. I CQ i ; $ $ <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 <br /> access to the above de bed promises at any reasonable time for the purpose of inspection. m <br /> m i <br /> M <br /> SIGN <br /> (sl of owner ding contractor) (date) <br /> u <br /> ZONING ADM(NISTRATOR <br /> TOWNSHIP PER ITS MAY BE REQUIRED o OZ��' )5. !B In <br /> m <br /> 9888 8 U) <br />