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Burnett County 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administrator W ,o&)-\-Po <br /> APPLICATION FOR - LAND USE - PERMITS � �. f <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and a � C� <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the a re <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and $ <br /> regulations of the Stale of Wisconsin. w m <br /> OWNER J\Irv, C)-��� (.&f TELEPHONE F <br /> ADDRESS VVVVVV�CCC��Ioat l �f�( X �LO <br /> EMERGENCY/FIRE NUMBER ROAD NAME r (L5 <br /> LEGAL DESCRIPTION (see tax receipt) V 77- <br /> 1I <br /> _ <br /> CONTRACTOR <br /> ���,4CA:" <br /> �)�, �iii �n 1 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARA FJACCESSORY STRUCTURE ADDITION V p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION /\ r' <br /> T o �. <br /> T <br /> � r <br /> STRUCTURE/ADDITION USE: o � <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) v <br /> Z d <br /> 0 0 <br /> m <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 (N),septic tank (ST),and drainfield (DF). 5 <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 and <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 111 o y <br /> PLOT PLAN Z <br /> nP u IZ <br /> M LJ <br /> I <br /> � y <br /> 0 <br /> N �m <br /> o <br /> w <br /> Z <br /> g �DE m <br /> e. kr Z H <br /> CONDITIONS OF PERMIT: o 3' Q g g g 331. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z ` ''2 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. a to <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ' r^ `: mm <br /> c <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 I am responsible for the detail and accuracy of all Informs- m <br /> tion contained in this application(Including any accompanying schedule)and I further declare that 1 recognize that this infor- f" $ <br /> mation I am providing will be failed 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 penult 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 /> $ <br /> i <br /> SIGN HEREi <br /> « <br /> (signatureofowner or building contractor) (date) <br /> ZONING ADMINISTRATOR `-/I�����1 - <br /> $ j E <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> o tTi $R m <br /> ,il'iITn1'$' <br />