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Burrtelt County 7410 Co. Rd. K, No. 102, Sir's^'WI 541372 Office of Zoning Administrator � � -1 o <br /> APPLICATION FOR — LAND USE — PERMITS o <br /> by makes application for a Perm <br /> reed here for the work described and c <br /> TO THE ZONING ADMINISTRATOR:The urxfersig <br /> rements th <br /> located as shown herein. The undersigned agrees that ell work shall be done in accordance with lhe anid the laws and <br /> Burnett County Land Use Ordinance,Sanitation Code.and with all other applicable CountyOrdinances <br /> u m <br /> regulations of the State of Wisconsin. I q p $ $ O� <br /> OWNER �lJ j}�O/C .fJ,(�IN 6 TELEPHONE <br /> ADDRESS CO I STI_�1_ 1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME VI/�ner L�K� (Np <br /> LEGAL DESCRIPTION (see tax receipt) dot) zoo 1/ C rs ex) 1eC 6-b <br /> CONTRACTOR <br /> GARAGE/ACCESSORY STRUCTURE ADDITION <br /> c <br /> TYPE OF PERMIT(S): DWELLING BUIL <br /> c <br /> CA PING UNIT SUBDIVISION 0 �. <br /> SANITARY PRIVY FIL ING/GRADING _ <br /> 0 O <br /> I� O <br /> STRUCTURE/ADDITION USE: 11 - .I V <br /> (Home/Cabin;Commercial Business; Broom;Deck;etc.) <br /> R(hi-- 0 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 (NS) and Indicate North (N). <br /> 2. Show the location ofthe well (Vh septic tank(ST),and drainfield (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 O <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. Z CA <br /> o <br /> PLOT PLAN o <br /> C I <br /> See 4W: � <br /> 1 <br /> 'fee per <br /> 0 <br /> a <br /> O � <br /> w <br /> 1_ <br /> A <br /> 1 2 <br /> V <br /> A HTfiffl n <br /> cga� 3 <br /> CONDITIONS OF PERMIT: _ IQ ' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. b+ Eli <br /> n <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. i S ` <br /> i <br /> I declare that this application(including any accompanying schedule)has been examined by to and to the best of my knows- <br /> r <br /> edge and belief It Is true,correct and complete.I acknowledge that s am responsible for the detail and accuracy of all Informs. s �", ? t <br /> tion Contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor• ' <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a Permit. I 8 $ '. <br /> ing In <br /> further n.I agree <br /> all liability <br /> which maybe a suit of the County of Burnett relying on this informationother authorized amprovidereon to have <br /> &P- �6 <br /> plication.I spree to permit countyoffl any0n�in�e timeforthe purposecounty <br /> of ordinances <br /> spection. •n <br /> access to the above deeori <br /> SIGN HERE sig at re of o r orof bull no contractoq <br /> ZONING ADMINISTRATORN ~ <br /> TOWNSHIP PERMITS MAY BE REOUI . q ` , 6 M IIIA <br /> 888888188 <br /> i <br />