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Burnett County 7410 Co. Rd. K, No. 102, Sinn, WI 54872 <br /> - APPLICATION FOR — Office of Zoning Administrator �Croy <br /> TO THE ZONING ADMINISTRATOR:The LAND USE - PERMITS f <br /> located as shown herein. The undersig �hereby makes application for a Permit for the work described and Q0 *0 <br /> ° <br /> Burnett County Land Use Ordinance,SanN green t�all work shall <br /> be clone in accordance with the requiremerria of the s e <br /> regulationsofthe State of Wisconsin. Code,and with all other applicable County Ordinances and the laws and �. <br /> OWNER ' ,0��•N C $ m l <br /> .v —7 /^� J TELEPHONE (Z '� ��—Q ZS3 O <br /> ADDRESS � �/) -t-U12m m <br /> E..1 RLS <br /> EMERGENCY/FIRE NUMBER /-� <br /> V ROAD NAME ,� I <br /> LEGAL DESCRIPTION (see tax receipt) L I V m t ! I rE' rel <br /> V ,L, l -�l0 <br /> CONTRACTOR -DOU4 '- <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE Vl�- <br /> pR <br /> SANITARY o <br /> IVV ADDITION <br /> FILLING/GRADING <br /> CAMPING UNR SUBDIVISION " O <br /> STRUCTURE/ADDITION USE: ID/� I� / 0 o <br /> .Stro 4,5� Ci�'F7� / / <br /> w � <br /> (Home/CabinCommercial Business,Bedroom,Deck,etc.) <br /> 2T <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) o o' <br /> 1. Show the location and size of all existing buildings (EB) and alt new buildings (NB) and Indicate North (N). 3 <br /> 2. Show the location of the well (w) septic tank (ST),and drainfleld(DF). I <br /> measurement to the ordinary high water mark of lake,stream, or river. <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building0 <br /> I o <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and x <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSRE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. O 0 <br /> 0 <br /> PLOT PLAN SEE o ti <br /> Z <br /> 'n <br /> � o <br /> 9J <br /> b—� rea <br /> S,ep c t,:),-) d rywel/ <br /> N <br /> � d <br /> bv ' <br /> De 5/ea f-e-r <br /> of .14 ted road, <br /> 0 <br /> w Iili,-� <br /> n I <br /> r 2 <br /> S <br /> F <br /> CONDITIONS OF PERMIT: n o <br /> m � E R1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN e0 DAYS OF PERMIT ISSUANCE. Z e 8 m 0,8 ; <br /> a c g. — <br /> g - <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. p i , <br /> M <br /> 1 declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowl• i O <br /> edge and belief It Is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs• i <br /> tion contained in this application(Including any aor:om n '• f »G3 <br /> Mellon I am Providing will be relied upon Pa f Burnett schedule)and 1 further declare that I recognize suet Mir mit. I m <br /> further accept all liability which may be a rel It of the nC unt of Burnette elyinig on n in tuleeinformin it information providing In this ap- - O <br /> Plication.I agree to Dermis. I 8 g <br /> access to the ahoy�krycbbnty officials charged with administering <br /> county <br /> ount ordinances or other I am prod <br /> Premises at any reasonable time for the purpose of Ins person to have Inspection. <br /> SIGN HERE <br /> lgnature of ow bulWlnp contractoh — �'Z3- 94 » i <br /> (date) <br /> ZONING ADMINISTRATOR ���/// 1 <br /> TOWNSHIP PERMITS MAY BE REQUIRED 8 <br /> o lSn�'�!4 m <br /> 88888888 rvrni <br />