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r V com�/ <br /> Burnett County 7410 Co. Rd. K, No. 102, Sl , WI 54872 Office of 'of Zoning Adminl;trator 0 0 <br /> U, f <br /> APPLICATION FOR — LAND USE — PERMITS m o cA <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 shell be done in accordance with the requireme sof the $ <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the I and <br /> regulations of the State of Wisconsin. o m <br /> i o m <br /> $ O <br /> OWNER �au C I�r TELEPHONE 41 X L( Sa 0107 m £, <br /> ADDRESS -1$ 8 SQh ScL Dr Sko'c Urrl4J, M/j <br /> EMERGENCY/FIRE NUMBER ROAD NAME Li 11 y 1.4At< <br /> �^ v <br /> S p r <br /> LEGAL DESCRIPTION (see tax receipt) LD 4- 7 GSM VIq Pzg8 6t, S4J sE� 3(o T�/ rT LV —' <br /> CONTRACTOR LAA% IEC tde <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION X o I <br /> T Ul <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 �- <br /> 0 <br /> STRUCTURE/ADDITION USE: Screevt Por-C_ o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o 0 <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and size of all existing buildings (ES) and all new buildings (NEI) and Indicate Nort i (N). <br /> 2. Show the location of the well (W),septic tank(ST), and dralnfield (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. C <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and a <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE SSUED. 3 m <br /> 1A 2 a <br /> PLOT PLANA ° <br /> N o:�}tea M 10 <br /> K A ,. <br /> �1�f n Skew ( <br /> '1 <br /> t _ y <br /> lde <br /> Ow + m <br /> .�o Cab n SpprC raeh I� Vo � <br /> I .� <br /> W <br /> �EB� n <br /> Ngu Aeek <br /> I <br /> f`�\ l e ( 1 s e <br /> AJ Ca) <br /> ws <br /> \\\ Z <br /> S 0A t)wlr\ t <br /> S 0(t- V <br /> 1 <br /> d1 <br /> 2. m <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. 0 ! ; �'� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - t/g� ' a <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` �' ' O S : 0 <br /> Er <br /> 1 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 ill informs- m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize ths this infor. <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I '; $R $ <br /> further accept all liability which may be a result of the County of Burnett relying on this Information I am providin In this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized pe n to have <br /> access to the above described premises at any reasonable time for the purpose of Inspection. rwl <br /> r <br /> w <br /> SIGN HERE <br /> (siqnrVfqI r r building contractor) "Iaatal_L . <br /> ZONING ADMINISTRATOR <br /> tw. w <br /> TOWNSHIP ERMITS MAY BE REQUIRED ',t1 o ' ' l5 ' dpi a i'iE <br /> UU 888888',8'$ m <br />