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Burnett County 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administrator (�6n V, <br /> Q o <br /> APPLICATION FOR - LAND USE - PERMITS �_ £ <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work descri bad and � a <br /> Utl <br /> located as shown herein. The undersigned agrees that all work shall be done in accortlance with the requireme sof the o �v <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the 13WS and $ 1 <br /> regulations of the State of Wisconsin. <br /> OWNER { ` �C TELEPHONE <br /> G J V £ <br /> ADDRESS 201 2 <br /> V <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> 1 <br /> n <br /> LEGAL DESCRIPTION (see tax receipt) <br /> r <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a <br /> 0 <br /> N <br /> STRUCTURE/ADDITION USE: 0 0 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Z o <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 Nort (N). i�VNS <br /> 2. Show the location of the well (W),septic tank (ST), and dralnfield (DF). <br /> 3. Show dimensions Infeet of thefollowing:(a)buildingto all lot lines,(b)building to center line of road,(c)i building - <br /> measurement to the ordinary high water mark of lake,stream,or river. y�l' <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. o <br /> NOTE: BUILOING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE O SUED, 0 a N <br /> PLOT PLAN Z <br /> o n <br /> n <br /> M G <br /> 0 <br /> C <br /> P <br /> i <br /> I N <br /> r <br /> N <br /> ' l <br /> N <br /> r <br /> G Z <br /> 1N� � <br /> 1 <br /> F <br /> ao00 E[4 Magiv <br /> m <br /> CONDITIONS OF PERMIT: o 3.: ,z C g g NO ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN to DAYS OF PERMIT ISSUANCE. c £1. . %'2 � <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ` gN ` y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` �++ p i On <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of ff y know[. o i �E <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that t iis infor- l p <br /> C : <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing In this ap- ' <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized persoo to have o <br /> access to the above described premises at any reasonable time for the purpose of inspection. e <br /> T <br /> m <br /> SIGN HERE - _-. .. ' .1-: -• <br /> (date) <br /> ZONING <br /> ZONING ADMINISTRATOR ) <br /> p « <br /> TOWNSHIP PERMITS MAY BE REQUIRE } % RUNS m <br /> 89 8888w <br />