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Burnett County 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Adminiletrator 5 m <br /> APPLICATION FOR — LAND USE — PERMITS m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v a <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremer Is of the <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the I aws and <br /> regulations of the State of Wisconsin. <br /> m m <br /> c O <br /> OWNER <br /> vn TELEPHONE <br /> V. ( CL I a -211 Q 0 m <br /> u l l <br /> m <br /> ADDRESS . � . .� oy' �a) . [iLU j /Lilt, <br /> � <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> C <br /> LEGAL DESCRIPTION (see tax receipt) LGT a CJ I-1 V', �J P• �(o 4 � �(�� �-Cf pec•. <br /> CONTRACTOR C)U IZS ,V e S <br /> rrre or aen,.uT(o4, av+cc trio/BUILDING GARAGE/ACCESSORY STRUCTURE X ADDITION o <br /> n L7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION p ° <br /> ° <br /> a � <br /> STRUCTURE/ADDITION USE: tQ i 0 1 d O LU \ k , l ( tA- <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) °Z <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 drainfield (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. it separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE UED. IN KEN <br /> 1A Z a <br /> PLOT PLAN L(/Z_ 5. <br /> IlCt� e e1 �/ ST-2 � �/%C) fir, I�.'CL at 'k Ao a <br /> *o �, /�K e , cU e p i4 rk �. 5� , u�C t e � C-L" k In o <br /> W kwa h `, he 'q 0 Ft. `l C <br /> �vt�C 0 l T Tu , /24t,cx� w .' ll b � <br /> C' <br /> W <br /> g. <br /> /'L <br /> VU (( o <br /> �r QG d ° <br /> u,,,I y r y�Sfol U <br /> 1 O J <br /> m <br /> " . <br /> J <br /> peTfi 1—,aKe n �� Nj Im <br /> y R.: M <br /> CONDITIONS OF PERMIT: v < Z; c 8 g'' ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. c N I M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` �" O `: m0 <br /> ' 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 and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- ; i «m ; m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> matlon I am providing will be rolled upon by the County of Burnett Wisconsin in determining whether to iasu a permit. I ; $ $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providin I in this ap- <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized per n to have <br /> access to the above described premises at any reasonable time for the purpose of Inspection. <br /> Y <br /> SIGN HERE <br /> (sig I uro f owner Wing contractor) `- adatal p4 <br /> ZONING ADMINISTRATOR v k $ <br /> TOWNSHIP PERMITS MAY BE RECUIRED,; <br /> � I o �' ,a' >.5 5' �'�a"b' m <br /> OCT <br /> 27 � 88 $ $$ $ $$ un, <br />