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II ,per / <br /> Burnett Ceimty 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administrator C / m' /E 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 v m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremer Its of the $ <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the I 3ws and _ <br /> regulations of the State of Wisconsin. a m <br /> u o _ <br /> OWNER c3 tl ".4 etc TELEPHONE <br /> ADDRESS 70 '�J a 4/! <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt)0 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o , <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° I <br /> ° <br /> '^ r <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z <br /> o ° <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) �1 <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 dralnfield (DF). g <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. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAID FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1A o rn <br /> PLOT PLAN Z o <br /> o m <br /> C <br /> s � o <br /> O <br /> O <br /> O y <br /> N <br /> I� <br /> Z <br /> S <br /> C5 <br /> Ecr m <br /> CONDITIONS OF PERMIT: C 8 g ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Y`z i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. i >7 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` a O C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best o my—knowl- <br /> edge <br /> nowl- <br /> �es c <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of II in forma <br /> y! In <br /> lion contained in this application(including any accompanying schedule)and 1 further declare that 1 recognize that this infor- ; p <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 i $Y $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 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 above described premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE E <br /> (signature of o nv or building contractor) (dal ) pg{ <br /> ZONING ADMINISTRATOR Inqn I 8 <br /> TOWNSHIP PERMITS MAY BE REQUIRED - o i'��' S '_8m <br /> 888888188 In <br />