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Burnett County 7410 Co. Rd K, No. 102, Sinn, WI 54872 Office of Zoning Administrator y o o <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATO :The undersigned hereby makes application for a Permit for the work described and Q m <br /> located as shown herein. The u Weighed agrees that all work shall be done in accordance with the requirements of the a Cc <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. <br /> OWNER g6Zj14 /r 1� �. TELEPHONE 7� 1��� / Zt-'b o f <br /> 11 ,�r,, m_ <br /> ADDRESS I Z Z \ L <br /> EMERGENCY/FIRE NUMBER HC <br /> ROAD NAME <br /> LEGAL DESCRIPTION (sae tax retail N0�ji <br /> CONTRACTOR J IV -) P �` <br /> TYPE OF PERMIT(S): DWELLING/BU LDING GARAGE/ACCESSORY STRUCTURE_X ADDITION p <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION —o ° <br /> :. <br /> / ( w r <br /> STRUCTURE/ADDITION USE: 57'4btF o ° <br /> (H me/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> m <br /> DIRECTIONS FOR PLOT PLAN C RAWING: (Aerial or top view) '< <br /> 1. Show the location and size ol 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 dralMield (DF). <br /> 3. Show dimensions In feet of tint following:(a)building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordinary ilgh water mark of lake,stream,or river. <br /> 4. If separate plans are submitte I by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. O <br /> NOTE: BUILDING/STRUCTURE LOCAI ONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 111 o m <br /> c <br /> PLOT PLAN �O / A .. n <br /> o <br /> a <br /> rn — <br /> 9j <br /> NSr� I Ccns <br /> 3" <br /> Vt 0 <br /> N / I�J <br /> �Zot 00 0 {I� <br /> O aOX7a` Tb LAW <br /> M Dr �3 C <br /> 41I+ <br /> my� <br /> CONDITIONS OF PERMIT: L rT ��� J✓lt Po o ;: Z C 8 ; <br /> 1. DRIVEWAY MUST MEET DRI SWAY WIDTH REQUIREMENTS WIT IN r DAYS OF PERMIT ISSUANCE. Z e Z <br /> 2. REMOVAL OR CUTTING OF REES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> P <br /> 3. NO GRADING OR SHORELA D ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. rczi " i O rn <br /> I declare that this application(Incl ding any accompanying schedule)has been examined by me and to the best of my knowl• f <br /> edge and belief it is true,correct a d complete.I acknowledge that I am responsible for the detail and accuracy of all informs- E « « : m <br /> tion contained in this application <br /> in <br /> any accompanying schedule)and I further declare that I recognize that this infor- i i $ p <br /> mation I am providing will be real upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 $ 8 <br /> further accept all liability which m 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 fficlals charged with administering county ordinances or other authorized person to have ' <br /> access to the above described pn miss$at any reasonable time for the purpose of Inspection. <br /> T <br /> m YYY <br /> « <br /> SIGN HERE <br /> u r ullEing contractor) (date) Q..)i E <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP P MITE MAY BE REQUIRED 8 8 8 8 8 glglg rn <br />