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BuMsft County 7410 Co. Rd. K, No. 102, Sinn, WI 54072 Office of Zoning Administrator 5goc <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � a <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the IaNs and $ <br /> regulations of the State of Wisconsin. m m <br /> u o <br /> c O <br /> OWNER�rc f TELEPHONE <br /> ADDRESS M <br /> EMERGENCY/FIRE NUMBERSaw <br /> ROAD NAME ROAD NAME <br /> D <br /> LEGAL DESCRIPTION (see tax receipt) <br /> ` rl <br /> CONTRACTOR V <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ? e <br /> II 0 <br /> STRUCTURE/ADDITION USE: h U in 4R -4 13. V 13, J l✓ S K f3• '[ be, ii <br /> (Hom Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> 0 0 <br /> v <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 (V ),septic tank (ST),and drainfield (DF). I 5 <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I 3 m <br /> PLOT PLAN <br /> See q / ��� O��^� <. <br /> C ' <br /> a � <br /> In <br /> } < Ib <br /> 0 ' r <br /> �l I <br /> d <br /> O y <br /> w <br /> Z <br /> I M <br /> o g� IF a <br /> CONDITIONS OF PERMIT: S z'i Z C r8 g 4 ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Ze Q i <br /> 0 E <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ^�„; i �tT m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. _ S P <br /> 5E <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the beat 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 informs- ? «a « m <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize that ihis infor- i i i <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. r' ? $ 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing i n this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have 0: <br /> access to the above described premises at any reasonable time for the purpose of inspection. i <br /> SIGN HERE " '• « E <br /> ( n roof ow r building contractor) (date) �t <br /> i Ei i <br /> ZONING ADMINISTFIAT ' g <br /> TOWNSHIP PERMITS MAY BE REQUIRED ONN+'NMN+• m <br /> lX4KS54� $ <br /> 88888588 a, <br />