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071 ec)71p, <br /> Burnett County 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administrator c o f c <br /> APPLICATION FOR - LAND USE - PERMITS m <br /> TO THE ZONING ADMINISTRATOR:The u F ° <br /> undersigned hereby makes application for a Permit for the work described and a� Q <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the o c <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and $ S <br /> regulations of the State of Wisconsin. o <br /> 4 Ot <br /> G � <br /> C <br /> OWNER R)P Fiv-so- l TELEPHONE �I7 _ 6�. 71 jo v O <br /> I1 1V • r ��••r'' ff II'' � � <br /> ADDRESS 4M S+h S�r. SE M VLS <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> 1 <br /> LEGAL DESCRIPTION (see tax receipt) Y <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n oO <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> a <br /> STRUCTURE/ADDITION USE: 0 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) T <br /> Z o <br /> 0 c <br /> } <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 draiMield (DF). <br /> 3. Show dimensions In feet of thefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building pn <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 9 <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 3 y <br /> PLOT PLAN A o 'o <br /> N o <br /> Cwiq O = <br /> In7V z <br /> 0 <br /> IN <br /> _ <br /> _ <br /> m <br /> o <br /> w <br /> Z <br /> g- <br /> my <br /> CONDITIONS OF PERMIT; v _:: Q C 8 8(3 ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. e Z 1 <br /> 2, REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - rn`- XI <br /> g <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ' �: S ` I m <br /> Lr C <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of 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 <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize that this Infor- — <br /> mation 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I 81 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 <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE <br /> 999 / <br /> ( (date) <br /> '. € <br /> ZONING ADMINISTRATOR �: 8 <br /> TOWNSHIP PERMITS MAY BE REQUIRED ( ' g m <br /> 188$ 8,88 a) <br />