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f}(f�N7�ioe1 ; JiFr 6I1 V%uy�i <br /> Bumett County 7410 Co. Rd. K, No. 102, Simn, WI 54872 Office of Zoning Administrator m g o <br /> APPLICATION FOR — LAND USE — PERMITS f m 3. o <br /> TO THE ZONING ADMINISTRATOR:The here undersigned g by makes application for a Parma for the work descri d and m i' <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirement of the $ �, <br /> ob <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the la s and _ <br /> regulations of the State ct Wi opsin. w m <br /> IIamS War/ p_o'.* jZe50� �6'�) Pi <br /> OWNER j rCe !�t_a TELEPHONE C71S)aha -s57o a E <br /> m <br /> ADDRESS /�(i/�O <br /> �. <br /> EMERGENCY/FIRE NUMBER /�,/�0 ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) e <br /> i ` <br /> CONTRACTOR Se '�- <br /> t <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDRION o <br /> c1 T <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> A , <br /> �^ r <br /> STRUCTURE/ADDRION USE: IC ^'1 �U' r) �� 5 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z a <br /> o c <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). <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c) ullding <br /> YF <br /> measurement to the ordinary high water mark of lake,stream, or river. 0 <br /> 4. if separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sig ed and 9 P <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE UED. a m <br /> PLOT 4AIN <br /> Sot I p (CJ —S in P n <br /> Wm y <br /> C 'L <br /> - - X� <br /> / W m <br /> O <br /> N <br /> e- <br /> ' <br /> —7 �Pp- *a`r)5 <br /> R <br /> G <br /> a DFS '-BnN gm y <br /> v a 3, g 9 <br /> CONDITIONS OF PERMIT: < Z c ffi 'B <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <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 E ` m <br /> i �Lr € c <br /> a , <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of 0 y knowl- o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of a I informs. �+m T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue I permit. I <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing n this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized pars n to have m' m <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 3 <br /> m o w <br /> SIGN HERE <br /> ($l atu of ow r Duildfnp contractor) <br /> ZONING ADMINISTRATOR <br /> I. I wNd.�ww-1 -n <br /> TOWNSHIP PERMITS MAY BE REQUIRED j; Z `� o N 8 a "n SS m <br /> j� .� 88$ 88888 y <br /> I <br />