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00 wflpj <br /> Sumett County 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administrator 5 y - a <br /> APPLICATION FOR — LAND USE — PERMITS m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby by makes application for a Permit for the work desc 'bed and a <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m = <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. <br /> u m <br /> c <br /> OWNER C 1 1 TELEPHONE ' r O C /' n <br /> ADDRESS w Ira n= EF p R FAL" <br /> 1 J; m <br /> l� 1 ` � <br /> EMERGENCY/FIRE NUMBER oo AS ROAD NAME s:ri1 Ar'V - O <br /> LEGAL DESCRIPTION (see tax receipt) a>TZ --, <br /> i <br /> CONTRACTOR S L F \ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE _ ADDITION p (l, <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo o l <br /> nn �� N <br /> STRUCTURE/ADDITION USE: ` R-Ab:F 7ro Mw Si <br /> r Home/ bin;Commercial Business Bp�r Wk;etc.) Z <br /> J 1S A o ° <br /> c <br /> M <br /> a <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 (VI),septic tank (ST), and drainfield (DF). o <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. <br /> 4. H separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be al ned and 9 <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I a m <br /> PLOT PLAN `v <br /> p n <br /> N 4 Ki 2 � <br /> 4 <br /> a < <br /> rn <br /> ` I <br /> AVV X00 DIV <br /> � <br /> r <br /> L�b�OD <br /> R <br /> N 0 <br /> & j0 XJ <br /> 7.h � �� <br /> r A <br /> r <br /> lt?Y A pgry%i+ Aro J Z <br /> tC+ Y►1QU �XlSfln9 _— �_ —__ /SYS. �c Z <br /> qf`tpj�9F An.D 1-6 <br /> I Y� Y <br /> x'yt1, DRA n�'I4• <br /> IrelacafE ah t-h£ ��A" 1 <br /> spot wh E m *VIE- <br /> old pontool-% bo44- is T <br /> Kr <br /> 4. Z. ff <br /> CONDITIONS OF PERMIT: a � <br /> Z. Q c a g 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIRE ENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o FI <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ' JI N`• y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. - r^ :` �, E m <br /> I declare that this application(including an accompanyingschedule has been examined b me and to the best of �' <br /> i E ' C <br /> PD ( 0 Y 1 Y Y knows- ? y <br /> edge and belief it is true,correct and complete.1 acknowledge"that I am responsible for the detail and accuracy of of informs- <br /> 8 a 8 ; in <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that his infor- i <br /> motion I am providing will be relied upon by the County Of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing I n 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 /> aoQ) O iP <br /> SIGN MERE - <br /> (sig t ofowner b Iding contractor) fe <br /> ZONING ADMINISTRATOR ��"-- II $ <br /> TOWNSHIP PE ITS MAY BE REOUIR y`A FEB 2 2 <br /> "' 88888888 umi <br />