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Burnett County 7410 Co. Rd. K. No. 102, Si an, WI 54072 Office of Zoning Administrator rn o c <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the $ <br /> Burnett Count'Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and _ <br /> regulations of the Stale of Wisconsin. m m <br /> m <br /> T001 A)OROIErJSTQ fn C O <br /> OWNER TELEPHONE f <br /> ADDRESS I U nG ,e S—I /yt r` SS S 14 • i <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> L,OI.J m �vtA)r-te L1ileL Pp ^ � <br /> LEGAL DESCRIPTION (see tax receipt) <br /> Lr t of ra rrt v <br /> 9-1 <br /> CONTRACTOR Id0RT111/W0 RLf.6.t.AT10A7Al FW/71tS Irk t <br /> gbure 10 SoX i41A 144yuim"3 ta" 5`134A bay - 6.3[,L <br /> TYPE OF PERMIT(S): DWELLING/BUILDING ,/ GARAGE/ACCESSORY STRUCTURE ADDITION o SZ <br /> n !7 <br /> SANITARY `X/ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> 0 <br /> STRUCTURE/ADDITION USE: 1�G0�^..�.�, <br /> (Home/Cabin; mmercial Business;Bedroom; Deck;etc.) ..�- V l�.-t'7,//, o ° <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 North (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 Lj <br /> measurement to the ordinary high water mark of lake,stream, or river. Q <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. Q <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSrTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 o to <br /> 41_ Z c <br /> PLOT PLAN n ° N <br /> i a <br /> 491' <br /> l4'r,no, r <br /> :udLL O IILT�. <br /> v <br /> z <br /> to <br /> i <br /> 3Got � n <br /> -9 <br /> t 1 <br /> LOwF:R MsKwz.ld. LAkf @p g �' <br /> m S� 2. <br /> CONDITIONS OF PERMIT: 3 <br /> 1. DRIVEWAY MUST MEET ORNEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. a Si i 22 H <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. '• r" '• ': C <br /> QE ' C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- S: n <br /> edge and belief it Is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs• O " ; y! Y_' <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor• r•; S 75 C <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 $ $ E <br /> further accept all liability which may be a result of the County of Burnett relying on this information I an providing in this ap- <br /> plication.I agreitto permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the ribed premises at any ressonable time for the purpose of Inspection. m <br /> i <br /> CDAWA <br /> SIGN HE <br /> q 4 <br /> IC) 3' <br /> /l ores u of sorter or but 1 g wntractor) (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED 8 <br /> �8 8 8,. <br /> I <br />