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Burnett County 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administrator l o o ' o <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m ° <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m <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. u g <br /> OWNER,.N�'NN J J7r,GTELEPHONE <br /> ,,11 �j '"� / /J Hor�� /zg2�yJ E✓£[E7i{ �4' ,- <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER p_Y'2Q Z_ ROAD NAME <br /> 6' <br /> LEGAL DESCRIPTION (see tax receipt)1-6-r L 4fS4n V1 o 275 <br /> CONTRACTOR 41dAIC <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O <br /> � L7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Z o <br /> 0 0 <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 drahttield (DF). a <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 9nd 9 <br /> dated by the owner. C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSRE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. an v <br /> KEm <br /> 1A Z o <br /> PLOT PLAN <br /> � e <br /> I � <br /> -57€- 4-(Wic aFF�) IW4W j - 1`j- a <br /> In <br /> /1i0te — SC*eev Pouae b e I t o ( G <br /> O <br /> a <br /> O y <br /> Z <br /> 1 n <br /> F <br /> CONDITIONS OF PERMIT: g.�: ? g 8 g$ Ic <br /> I. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z e ° - ,2 21M <br /> p <br /> EE : 9 <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. 11 r" ' O C <br /> C <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my kpowl- S <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all inibrma- m <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 a permit. I <br /> ? $ $ <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 abo des bed D isea y reasonable time for the purpose of inspection. .n <br /> SIGN HERE <br /> (sl o owner orimilding contractor) (data) <br /> ZONING ADMINISTRATOR i ' g ` '• ' <br /> was±swisi�s j' 71 <br /> TOWNSHIP PERMITS MAY BE REQUIRED o IX i)' is G° 3''a')5 m <br /> 888888i8�8 vmi <br />