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Burnett County 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administrator m <br /> 0 E q <br /> APPLICATION FOR — LAND USE — PERMITS m _ <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 2 Z ° <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirem nts of the m c <br /> Land <br /> Burnett County LaUse Ordinance,Sanitation Code, and with all other applicable County Ordinances antl tit laws and & <br /> regulations Of the State of Wisconsin. – o <br /> w d <br /> fO m I <br /> c <br /> OWNER �-�R 'LD P� TELEPHONEryD n T £ <br /> 9 / O ( � <br /> ar)-- 4-5 <br /> ADDRESS 7 +y f Lf}G-ovn: L tti Q / m <br /> EMERGENCY/FIRE NUMBER SU <br /> '7t{-cT,r� ROADNAME ��J� L, (� <br /> lb 19 <br /> LEGAL DESCRIPTION (see tax receipt) 1 hS C O Oa -- rp e 0OL7 - r <br /> CONTRACTOR S�J�ff 9 E <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTUREADDITION o <br /> SANITARY_— PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> o STRUCTURE/ADDITION USE: (S GX `° r <br /> o ° <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z <br /> 0 0 <br /> 0 <br /> m <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 Nolth (N). <br /> 2. Show the location of the well (W),septic tank (ST),and dreinfield (DF). a <br /> 3. Show dimensions in feet ofthe following:(a) building to all lot lines,(b)building tocenter line ofroad,(c)building <br /> yl <br /> measurement to the ordinary high water mark of lake,stream,or river. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. C O <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 3 N <br /> PLOT PLAN h L"w <br /> A ' <br /> C I s <br /> )v / a <br /> m <br /> 0 <br /> 1 <br /> F3 <br /> � 41 <br /> - 6 = <br /> l l I N <br /> 0 <br /> tv m' <br /> 1 <br /> d5c M <br /> b°o .9r <br /> r <br /> y 9� ADo � <br /> _/�}c-o��.1 Ln1 , +gel✓�r-net RaR� — — � X'�'�. � a <br /> g EL <br /> COND RMIT: a m z.: c $ 31 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c �.8 : r. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. f'n E m <br /> $ E : i <br /> C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best ofy knowl- <br /> m <br /> 4 <br /> edge and belie)it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of al;infformsrms- m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize thathis infor- i dap- <br /> p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue permit. I gr$ $ <br /> further accept NI liability which may be a result of the County of Burnett relying on this information I am providing n Chia t. 1 7(� <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized Persin to nave v <br /> access to the atlo ribed premises at any reasonable time for the purpose of inspection. P <br /> CD <br /> SIGN HERE `l, _ r <br /> gn uro f owner (ding contractor) <br /> (date) <br /> ZONING ADMIN TRATOR , i I � 8$ <br /> TOWNSHIP PERMITS MAYBE REQUIRED <br /> oU� iS� KtSm <br /> vmi <br />