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Burnett County 7,410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administrator U <br /> APPLICATION FOR - LAND USE - PERMITS 8- 8 <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. m <br /> c o <br /> F <br /> OWNER <br /> 1-��(I�S ,IAC TELEPHONE o 1 l 1 �I f� <br /> �1 0 <br /> ADDRESS as <br /> EMERGENCY/FIRE NUMBER ` ROAD NAME _ IC <br /> 1 <br /> LEGAL DESCRIPTION (see ltax receipt) <br /> CONTRACTOR C ](1) <br /> TYPE OFT S) DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION O 1 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONp °c- <br /> STRUCTURE/ADDITION USE: y?" I LL lF�( !est" ° E <br /> (Home/Cabin;Commercial B z <br /> iness;Bedroom; Deck;etc.) aa <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). r <br /> 2. Show the location of the well (W),septic tank (ST),and drainf laid (DF). ° <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. Q <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 STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1A v <br /> PLOT PLAN P <br /> M w <br /> I� <br /> wee cheo(-- <br /> 1 <br /> � o <br /> m <br /> o <br /> G 1 <br /> n Ir I <br /> z <br /> D <br /> F k,T. nI F A <br /> � <br /> CONDITIONS OF PERMIT: X <br /> Z O' gi <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z <br /> P i 9 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. Si i <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �' Pr i 0 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- ': S <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informs- <br /> tion contained in this application(including any accompanying Schedule)and I further declaro that I recognize that this InforI <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. ; $ $ <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.1 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. T <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR '• $}`��!} - <br /> M. w <br /> TOWNSHIP PERMITS MAY BE REQUIRED o ' Ute'FX I!U�"s m <br /> 8 $ $ $$ $',$$ to <br />