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o <br /> Burnett County 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS ' <br /> I <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirementsof the <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the lws and _ J <br /> regulations of the State of Wisconsin. <br /> (� a o <br /> OWNER � � LGNf)If' TELEPHONE 066 - 7215 o .r <br /> ADDRESS Wo - 71 && R <br /> v' <br /> EMERGENCY/FIRE NUMBER 6610 ROAD NAME <br /> Tkfif f0efra/o -se SE% Ly� 'b of CLAwi 'Aivew sa.LL <br /> LEGAL DESCRIPTION (see tax receipt) .(39M� �b <br /> ' <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ CCESSORY STRUCTUR __ ADDITION_ _ o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o` _ <br /> STRUCTUREJADDITION USE: .SG12E�11� /�9r/SE /SP�D/flLlf'"1 7ROWi A&VIY614 <br /> t(1 J <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z r' <br /> ° L. <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). I 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. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sned and M <br /> dated by the owner. 0 p <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE LIED. 7I a m <br /> 11 Z `o <br /> PLOT PLAN ° <br /> n <br /> C <br /> z <br /> )CID,/ .I�f m � Z 11cJr� � � I <br /> (k-T <br /> kCi, VC= <br /> rkPAW III <br /> m <br /> No <br /> m <br /> E8 E6 <br /> z <br /> DBivE i,,, SII <br /> k � <br /> g fn <br /> CONDITIONS OF RMrr: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F '0 i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. rn- `• M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. J1: N f ' g ` RI <br /> X ` O <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- '. O l i ` C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of 11 informa- e.m•' T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize tha this infor- B ; p <br /> mation 1 am providing will be relied upon by the County of Bumett Wisconsin in determining whether to issues permit. I <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providinj In this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized pen on to have O: o, <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> w : <br /> IM <br /> SIGN NER �Lu�(i� <br /> date) « <br /> (sig of ow building contractor) ( : <br /> IE E <br /> ZONING ADMINISTRATOR [ E g <br /> aawwa««.a T <br /> TOWNSHIP PERMITS MAY BE REQUIRE 8 ! SIN 5 m <br /> 888888'88 U) <br />