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Bumett County 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Admir)istrator ) O o 0 <br /> APPLICATION FOR - LAND USE - PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <br /> b <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirem nts 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 Stale of Wisconsin. �, m <br /> 4 �^ <br /> $ O <br /> OWNER MGrIw1�tE- YlM 1 TELEPHONE �1h —9 _ f <br /> v 1 m <br /> // A m_ <br /> ADDRESS CII, "I I Vj W YJTQo , <br /> EMERGENCY/FIRE NUMBER 1 k ; Y / ( ROAD NAME/- <br /> LEGAL <br /> LEGAL DESCRIPTION (see tax receip <br /> CONTRACTOR <br /> V � <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAG CCESSORY STRUCTURE ADDIT ON p <br /> a O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> ° < <br /> w r <br /> STRUCTURE/ADDITION USE: cklblyj <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z <br /> o ° <br /> } 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O <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 dralydleld (DF). I o <br /> 3. Show dimensions In feet ofthefollowing:(a)building to all lot lines,(b)building to center line of road,( )building 11 <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 s goad and a <br /> dated by the owner. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. IN a <br /> PLOT PLAN ? o <br /> I CO, C <br /> t- - <br /> )40d�"�s� o <br /> .pL S <br /> 0 �Q <br /> A A- <br /> J <br /> t ab' m m <br /> NDIT NS OF ER IT: Z m 5r '2 <br /> t. DRIV WAY MU ET DRIVEWAY WI ENTS WITHIN 60 OF PER C y i <br /> 2. REM VAL OR NG OF TREES D STATION IS REST RELINE. P F ° i >7 <br /> 3. NO G DING R SHORELAND A E ONS ARE At UNLESS SPECIFICALLY ED. r" `• O In <br /> 1 eclare th t ication(incl any accompanying schedule)has been examined by me and to the Des knowl- , ` a <br /> let it is true,conic omplete.I acknowledge that I am responsible for the detail and accuracy or all in - ? a m <br /> ti n contained in this applic on cluding any accompanying schedule)and I further declare that 1 recognize th t this info'- p <br /> m tion I am providing ad upon by the County of Burnett Wisconsin in determining whether to issuea permit. I �; ; $ <br /> fu her accept all lla y w may be a result of the County of Burnett relying on this information I am providingIn this ap- ' <br /> plication.I agree t county officials charged with administering county ordinances or other authorized per n to have <br /> access to t ve ribed promises M any reasonable time for the purpose of inspection. <br /> T <br /> m <br /> SIGN HERE <br /> (signature of owner or build a ntractort IdalaiLai <br /> ZONING ADMINISTRATOR —� J' <br /> TOWNSHIP PERMITS MAY BE REQUIRED �o v' S G«' 1X t S m <br /> 8888 '8 U) <br /> 88 <br /> i� \� <br />