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Burnett County 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administrator o O o <br /> APPLICATION FOR — LAND USE — PERMITS <br /> - m o <br /> TO TUE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v 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. w m <br /> w m <br /> O <br /> OWNER TELEPHONE <br /> Gerald It F{ancen 3'f9- 1269 'oto <br /> ADDRESS 24/99a Hu)v 35- ND -S,r,e.Kr W17 e ( <br /> ROAD NAME K <br /> EMERGENCY/FIRE NUMBER , <br /> .29/495- (3onner �.gke_ RoQol <br /> LEGAL DESCRIPTION (see tax receipt) O �'QT of Q O N I7 Q V` I'Q K �- <br /> CONTRACTOR /I 7-o rJ n O f J 4 G K$D t L <br /> GhdEItt CNWtth ed <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> ° » <br /> STRUCTURE/ADDITION USE: �O In 10 ° <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z o <br /> o c <br /> m <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). 2 <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building -1 <br /> measurement to the ordinary high water mark of lake,stream,or river. <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. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. ON o rn <br /> �_ Z co <br /> PLOT PLAN ° <br /> See_ c,& Lir a <br /> : <br /> OA�St�I� o"' r)-18-95' QSta6l•skE( 000,01. 44" lev4 v ae rak M n <br /> s et rat 9s� TO:f6AGk <br /> d's+obi'4Q <br /> ,F o N:w✓ff). n p <br /> - Rea- i"_rew Ripe a�SWeortiero� �vt !4S°z` �or �rs:-� MQIC�G <br /> fA <br /> 71) <br /> 477 D-H <br /> /74,c 73 Pk "P"-',r 9"z-f `1Z ryWe-t?5� rtfb• � a 1 <br /> 4i <br /> c_1 <br /> Z <br /> 2IJ :h( <br /> y <br /> g H,��'�-aom <br /> ff-* --a@ <br /> CONDITIONS OF PERMIT: o �' 'z c 8 = 'B Ic <br /> i. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. a EQ : : "1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ^�,i j gN m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> QQ Lr C <br /> SE <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 informsm <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize that this infor- E g ; p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a penult. 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. r <br /> SIGN HERE <br /> (rignatun of owner or building contractor) <br /> ZONING ADMINISTRATOR0 FOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED S5 fS m <br /> 99 9 ..1,N ami <br />