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&?� ("0)-)�. <br /> Burnett County 7410 Co. Rd. K, No. 102, Stren, WI 54072 Office of Zoning Administrator m 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes _ <br /> located as shown herein. The u g application n for r Pence for the work described and a <br /> ndersigrtetl agrees that all work shall be done in accordance with the requirements of the u <br /> Burnett County Land Use Ordinance,Sanitation Cafe, and with all other applicable County Ordinances and the laws and I . <br /> regulations of the State of Wisconsin. <br /> c m <br /> OWNER r E GOQ TELEPHONE <br /> 612 _ 7 70--o S7,-7 c f <br /> ADDRESS a m <br /> EMERGENCY/FIRE NUMBER 3 /�� ROAD NAME Alhit-m / F}��E- '\� 1 <br /> L� 1 7U <br /> LEGAL DESCRIPTION (see tax receipt) Q <br /> I� <br /> CONTRACTOR � <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> STRUCTURE/ADDITION USE: o ° :7_ <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z (� <br /> 0 0 <br /> i� <br /> 1 <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). <br /> 3. Show dimensions In feet of the following:(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. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ON§Irf VER ERMfT CAN BE ISSUED. IN 3 y <br /> Z v <br /> PLOT PLAN <br /> �X <br /> fill <br /> S <br /> e <br /> 0 <br /> ) o <br /> m <br /> L <br /> V Z <br /> M <br /> / I 1 <br /> 37/ 7 <br /> T Lo; � Mo <br /> MKLLR-(Z) LA-KERoAD g� a�F <br /> CONDITIONS OF PERMIT: � H��� .111H FI M <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 130 DAYS OF PERMIT ISSUANCE. oZ 'Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. y'• E <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r" '• g$ G <br /> �` C <br /> I 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- yy!�pp m <br /> tion contained In this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- E fig ! p <br /> Mallon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I f $ $ <br /> further accept all liability which may be a result of thtQQunty of Burnett relying on this information I am providing In this ap- ' <br /> plication.I agree to permit county officials chargp"thministeohli county ordinances or other authorized person to hwe <br /> access to the above3jejilcqbed premises at any awn let fOt t purpose of Inspection. <br /> SIGN HER �! <br /> (s ure 1 n r or I g c ntractor) ate) $ <br /> O i i <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMIT MAY BE REQUIRED o d�I ZSIY'15 m <br /> 888888'i8�8 N <br />