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Burnett County 7410 Co. Rd. K. No. 102, Sinn, WI 51572 Office of Zoning Administrator l cexzW T1 ' Z <br /> APPLICATION FOR - LAND USE - PERMITS ° <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v = _ <br /> located as Shown herein. The undersigned agrees that all work shall be done in accordance with the requirement <br /> Burnett County Use Ordinance,Sanitation Code acrd with all other applicable Courriy Ordinancend the awe and W <br /> regulations of the <br /> St IN/State Wlscons/in�. /^ -X-'OWNER IT <br /> r )s-s TELEPHONE 7/s <br /> ADDRESSPS8 7`A� <br /> Syo a <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> .SOOp <br /> LEGAL DESCRIPTION (see tax receipt) Scc S f .S T3,? ,,U <br /> CONTRACTOR h <br /> i <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE <br /> ADDITION o <br /> SANITARY__ PRIVY FILLING/GRADING CAMPING UNIT <br /> SUBDIVISION 0 <br /> ° o <br /> STRUCTURE/ADDITION USE: ' <br /> (Home/Cabin,Commercial Business;Bedro ; Deck;etc.) � <br /> G <br /> 2 0 <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 (N B) and Indicate North (N). <br /> 2. Show the location of the well (yi),septic tank (ST),and dralnfield (DF). r r <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building I o <br /> measurement to the ordinary high water mark of lake,stream,or river. 71 <br /> 4. H 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. O o <br /> PLOT PLAN Z <br /> o <br /> o FV' <br /> SI I n <br /> C L ' <br /> s <br /> cc+ <br /> N <br /> O <br /> I� <br /> b <br /> O <br /> N <br /> CONDITIONS OF PERMIT: u �g� -.0. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. 2 C <br /> 2 g0 � <br /> i <br /> —' <br /> . REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. 5) ` <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> I declare that this application(Incfuding 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 Informa- <br /> tion contained In this application(including any accompanying schedule)and I further declare roar I recognize that this Inlor• C <br /> mation I am providing will be rolled upon by the County of Burnett idea an I f rt determining whether to issue a • <br /> funkier accept all liability Perm which may be a result a the County of Burnett relying on this information I am providing in permit,his I <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to Me above described primites n any naapnable time for the Purpose of Inspection. <br /> -n i <br /> SIGN HERE�� 4o-lr° <br /> (tipnatun of••owy-nor or building contractor) (date) ? r«+ <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED moi m <br /> op An <br /> ant <br /> 8881i <br />