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6n • <br /> Burnett County 7410 Co. Rd. K, No. 102, Stan,WI 54872 Office of Zoning Admini tiretor u o c <br /> APPLICATION FOR — LAND USE — PERMITS >< <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q a <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 State of Wisconsin. m m <br /> m ,n <br /> OWNER na��� TELEPHONE `7 3 -6 a <br /> !o/aZ - Q f <br /> ADDRESS -7,3(o ou-Gr- Lr- ✓ L 4W le- VCt I M. 0 ;} <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) �.��' ��r�-rr 3� '� 5'w r �� 7"VOA, ' <br /> /as <br /> CONTRACTOR r14- fr;� n <br /> r�e04i <br /> S t ,,.�. <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY TRUCTURE ADDITION o —\ <br /> � O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o o <br /> IL I 0 �L_ <br /> m r 1 <br /> STRUCTURE/ADDITION USE: "f0 ra o <br /> v <br /> (Home/Cabin;C§nAercial Business;Bedroom;Deck;etc.) 0 d <br /> 0 o c <br /> m f <br /> a <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 thefollowing:(a)buildingto all lot lines,(b)buildingto carrier line of road,(c)building <br /> measurement to the ordinary high water mark of lake,stream,or river. 0 U <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sl ned and 9 <br /> dated by the owner. C ; <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE SSUED. 1I a y <br /> 71 z o <br /> PLOT PLAN <br /> M o <br /> 75 <br /> i n <br /> O <br /> D IBJ L,� �O1 <br /> m <br /> LI-s <br /> �® 0� 0 <br /> 'ger` <br /> 30 / <br /> rnv aavv <br /> c <br /> R R.a m <br /> ��_ > 100 e, a g� a$ a m 33 <br /> CONDITIO SOF PERMIT: \I )--1f31 � •��' = <_,w': ? g �8 <br /> 1. DRIV Y MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. a 0 w Q <br /> 2. REMO L OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N M <br /> 3. NO G DING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N m <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best o my knowl- m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- ` a a H i m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize th this infor- E $ E p <br /> motion 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 providin in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized ps In to have O o <br /> access to the above described premises at any reasonable ta for the purpose of inspection. <br /> -n i $ <br /> ID ' <br /> SIGN HERE d' ' <br /> (signal wner or building contractor) (date) a' <br /> ZONING ADMINISTRATOR <br /> HM N~fJNNyT <br /> TOWNSHIP PERMITS MAY BE REQUIRED o n 6 v u N m <br /> 88888888 vi <br />