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Burnett County 7410 Co. Rd. K, No. 102, Sinn,WI 54472 Office of Zoning Administrator H 0 0 <br /> APPLICATION FOR - LAND USE - PERMITS 5 ' <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v w <br /> a <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the a ,1 <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and $ g g' <br /> regulations of the State of Wisconsin. u ` �' <br /> c u <br /> OWNER Celt e /N�/,C_ p�•QL7 ZI F TELEPHONE <br /> ADDRESS '.PSrS ST�Te � a � Vf+t'f'��Vry �1, <br /> 41*��// O S <br /> EMERGENCY/FIRE NUMBER ROAD NAME S i I V-er- x'41 <br /> 4— <br /> LEGAL DESCRIPTION (see tax receipt)S E T S(,J S—J� - <br /> CONTRACTOR -7 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O <br /> O S <br /> °_ <br /> SANITARY X-_ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION (� <br /> Pei( <br /> N <br /> t'efm14-- <br /> STRUCTURE/ADDITION USE: v <br /> (Home/Cabin;Commercial Business;Bedro m;Deck;etc.) v z o' <br /> O p <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) I <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). c <br /> 2. Show the location of the well M0,septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions In feet of thefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building -4 -fy� <br /> measurement to the ordinary high water mark of lake,stream,or river. z <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and a <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMrr CAN BE ISSUED. 11 Z : v <br /> o <br /> PLOT PLAN C <br /> C O I <br /> N II <br /> Us <br /> 7 <br /> CIO <br /> c - <br /> l7 <br /> z <br /> O <br /> io :E <br /> fi <br /> CONDITIONS OF PERMIT <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. p <br /> R � <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. <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowl- g 1 <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs• <br /> lion contained in this application(Including any accompanying schedule)and 1 further declare that I recognize that this Infor- D 1 <br /> i 8 8 <br /> motion I 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&P- <br /> plication. <br /> tolthe above describedcounty <br /> pmmises at any reasonabharged with le for the purpose of icounty nspects nces or other authorized person to have T <br /> i <br /> SIGN HERE (� . I� M <br /> (signature of owner or building contractor) U -'_.S 0 ` '• <br /> ZONING ADMINISTRATOR A, , I994 <br /> WNSHIP PERMITS MAY BE RECUIRED f1W o <br /> TO <br /> ji 8888 8', <br />