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�1c <br /> 6- <br /> Burnet, County 7410 Co. Rd. K, No. 102, Siert, WI 54872 Office of Zoning Administrator S S /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 ° <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 /> regulations of the Stale of Wisconsin. a m <br /> u <br /> O <br /> OWNER TELEPHONE F <br /> SoD6 L, 1 Fck f -G <br /> uvea= <br /> ADDRESS• mriz [. C D 0 8Jkj <br /> EMERGENCY/FIRE NUMBERf_327 ROAD NAME/L+Cx1�;�aRb C) <br /> t6 <br /> S/Iq/Tvo/RIbvP Aews .'77o ^ m <br /> LEGAL DESCRIPTION (see tax receipq � 73 'PS j 47/r/50 PcL-i►yv/ /y001200 PCI, 60 LIE <br /> CONTRACTOR /��r <br /> o� P a,T � yL�7 ,� _ r <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBD VISION 0 0 e <br /> STRUCTURE/ADDITION USE: B/N )1,3 . G LC-Cd� a3G M, Sen • S4 <br /> (Home/Cabin;Commercial Bus ess;B room;Deck;etc.) z o <br /> 0 c <br /> m <br /> z <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 drainfleld (DF). o� <br /> 3. Show dimensions in feet of thefollowing:(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. C) a <br /> 3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 <br /> PLOT PLAN ° <br /> A o <br /> C C�) <br /> Ne . 11ey1�Lcu�Ia,v o� S��/✓�s ��yy'�/vL'tkJfs"`�. M <br /> s'1'At,e.l L«.-..j'ti wvL.-6-t <br /> s <br /> OIL o�s (,, � <br /> O -v <br /> 4 <br /> n <br /> z <br /> LN ID <br /> Te <br /> y f <br /> R T e �S G <br /> so m <br /> S - a <br /> 9 <br /> CONDITIONS OF PERMIT: 'R ,: Q a 8 S ' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. a 'Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. G <br /> M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> C <br /> 1 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 Informa- m <br /> tion contained In this application(including any accompanying schedule)and I further declare that I recognize that this infor- l5 `- p <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. 1 g 8 <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.1 agree to permit county officials charged with administering county ordinances or other authorized person to have n- <br /> access to the above described Dremlees at any reasonable time for the purpose of Inspection. 'n a5! <br /> SIGN HE E <br /> plgn o <br /> n wner or Ing contractor) <br /> i a <br /> ZONING ADMINISTRATOR L . . 8i '141 <br /> • <br /> TOWNSHIP PERMITS MAY BE REOUI ©o;IXg8 a' . m <br /> SEP 3 01994 � s s s 91 U <br /> __--- <br />