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Burnett Co;Snty 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administratar S f o <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and o <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the c C <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and <br /> regwiations of the State of Wisconsin. w m <br /> c m <br /> y O <br /> OWNER RATELEPHONE a� — J'✓�� 0 � m <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER .'j/�C�� ROAD NAME <br /> I <br /> LEGAL DESCRIPTION (see tax receipt) (p�, - (o -7 I&A r <br /> CONTRACTOR Pee F?::�r' SpnrS <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n 0 <br /> SANITARY�_ PRIVY FILLING/GRADING CAMPING UNITSUBDIVISION <_ <br /> w � <br /> � z o <br /> STRUCTURE/ADDITION USE: 0 <br /> T <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> o <br /> 0� ` <br /> �V � <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and size of all existing buildings (ES) and all new buildings (NB) and Indicate North (N). 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 .4 <br /> measurement to the ordinary high water mark of lake,stream,or river. C <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. o <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1A <br /> KE <br /> o n <br /> PLOT PLAN M o I <br /> C <br /> t I <br /> N <br /> �i <br /> o <br /> ' o <br /> m <br /> D,r2 lifts, <br /> ?"zz> Z <br /> R <br /> =K4 <br /> �2-� 21v <br /> m <br /> z• c"Sg <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o rn 9 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ' ? m <br /> CALLY PERMITTED. 10 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFI - <br /> L"; c� <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the beat 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 infonna- m m <br /> lion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> matron 1 am providing will be relied 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 I am providing In this W i iE <br /> plication.I ogres to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above dewr,bad premises at any reasonable time for the pu as of inspec ' T1 <br /> SIGN HERE (d <br /> pfacto <br /> atu f o nor or bu <br /> ZONING ADMINISTRATOR N wwwwT <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 88 E888 u. <br />