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Burnett County 7410 Co. Rd. K, No. 102, Sinn, WI 54072 Office of Zoning Administrator m 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 v v <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the $ <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and <br /> — o <br /> regulations of the State of Wisconsin. <br /> w e <br /> OWNER PAUL t/. HA SrW TELEPHONE <br /> m <br /> ADDRESS �03cq /�!$$. I 1/f' <br /> EMERGENCY/FIRE NUMBER �JJ' (!� ROAD NAME A <br /> LEGAL DESCRIPTION (see tax receipt) )6y yG6L OW 6f�/C,y i S/L)7rr�S <br /> mores Yowls SHAG <br /> ocwCTRACTOR �6 J/'`� jy - 3G/ySvN MASONRY �I/� S1 G✓/SC <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAG CCESSORY STRUCTURE ADDITION o <br /> n Lf <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> o < <br /> �flR��e ay -7 )/ w r <br /> STRUCTURE/ADDITION USE: 0 o <br /> v <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o d <br /> 0 <br /> } <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 (VV),septic tank(ST),and drainfield (DF). I ° <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. Q <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. Q <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSfTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1A 3 rn <br /> Z v <br /> PLOT PLAN O ° <br /> ROAD <br /> s <br /> C t ' <br /> i <br /> 1 , <br /> � 0 o � I <br /> I IV <br /> p� q Z <br /> —/— i n <br /> U � <br /> � R <br /> L �� o 2.a 2 <br /> 2I�Ov� AK az:: z3 <br /> CONDITIONS OF PERMIT: CS =,E <br /> t. DRIVEWAY MUST MEET DRIVEWAY REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o E 1,2 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` �" n 9 C <br /> QQEE <br /> C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the beat of my knowl- n <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- Yl? <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- E Yi 25 C <br /> mation I am providing will be felled upon by the County of Burnett Wisconsin in determining whether to issue •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 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 described premises at any reasonable time for the purpose of inspection. T <br /> a : <br /> SIGN HERE - <br /> (signature of owner or building Contractor) (date) <br /> ZONING ADMINISTRATOR r rm Ran 1,0(c <br /> TOWNSHIP PERMITS MAY BE REQUIREDo ' ' $, }5 r <br /> 8 $ $ 8 HIt <br />