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Burnett COW* 7430 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Adml�tistrator (Ao 0 <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 Z' a <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the M C � <br /> Burnett County Lard Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. <br /> v <br /> u m <br /> w io <br /> / r^ c <br /> OWNERSUE <br /> I E TELEPHONE �' _ b IG' C�g/ 7 a E <br /> G_ e7 o <br /> ADDRESS <br /> 1'.0 BOX OX 4 -5-T . PA U l M nl . 55 i 1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME7a DoC L.K r <br /> LEGAL DESCRIPTION (seetaxreceipt) 6� <br /> t <br /> CONTRACTOR -� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> SANITARY_X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> o �- <br /> � 0 <br /> w 0 <br /> STRUCTURE/ADDITION USE: ���1 .dim(, �R� pu; ( � TOG ? �i -� — )� c o r0 <br /> (Home/Cabin;Nmmercial Business;Bedroom; Deck;e d.) v <br /> Z O <br /> 0 v <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 Nor h (N). <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). V� o <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c i building IfiV <br /> measurement to the ordinary high water mark of lake,stream, or river. <br /> 4. N separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sl ned and 9 <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE SSUED. an c N <br /> PLOT PLAN A o 0 <br /> M o <br /> C = <br /> 14 f1` <br /> V{ <br /> , <br /> G <br /> 0 <br /> 0 <br /> _ <br /> IN <br /> m <br /> O y <br /> w <br /> 2 <br /> S <br /> I <br /> i; <br /> m <br /> ff� - a _ <br /> CONDITIONS OF PERMIT: a <br /> v g w:, 'RC g g'� � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. a E <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. : m <br /> B6 t O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- C <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 w m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that his infor- E <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue i permit. I gi 8 <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 ? O o <br /> access to the above described promises at any reasonable time for the purpose of inspection. m E <br /> SIGN HERE � _ <br /> ( (date) e' <br /> ZONING ADMINISTRATOR - <br /> . 8 : <br /> aNr• wNa T <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />