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on <br /> Burnett County 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administrator c V 0 o <br /> APPLICATION FOR — LAND USE — PERMITS <br /> o <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 o <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and $ �� <br /> regulations of the State of Wisconsin. �, m <br /> u n <br /> c <br /> OWNER a� (� TELEPHONE <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER � � / ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> G <br /> CONTRACTOR �,� � <br /> Fwc' <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GA GE/ACCESSORY STRUCTURE ADDITION p <br /> n L) <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o` °- n <br /> a � <br /> STRUCTURE/ADDITION USE: S °^ <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> o ° <br /> v <br /> 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) I ` <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 drainfield (DF). I o <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. <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. O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSrTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. o m <br /> PLOT PLAN ? S <br /> C- n-) C <br /> Z <br /> CA <br /> 0 <br /> o <br /> o <br /> G <br /> Z <br /> C <br /> An <br /> o y <br /> CONDITIONS OF PERMIT: = 2: IF <br /> Z C g ?L <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. g <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. m <br /> Er O <br /> fE ` i C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the beat of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all Informa• m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <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 Bumelt relying on this Information I am providing In this ap• i i ' <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR Ulm �idru��fl E 8 E p •` <br /> TOWNSHIP PERMITS MAY BE REQUIREDo L5 >' 'i5 m <br /> 888888',88 H <br />