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Burnett County 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administrator i m o (oz <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 /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m c <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the haws and 3 <br /> regulations of the State of Wisconsin. o <br /> OWNER TELEPHONE '�ls— / Oq— �� a E <br /> ADDRESS Z /49 <br /> G�/C D SSTD/,Vi✓ �/ . g m <br /> / L <br /> EMERGENCY/FIRE NUMBER �� 2 ROAD NAME eRds,S,TO(XON (p <br /> LEGAL DESCRIPTION (see tax receipt) 3o/'b-2 S2-3/`T38/7e18W -� <br /> 7�cc 38/Sz300z7oo <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION_ p G. <br /> SANITARY PRIVY FILLING/GRADINGCAMPING UNIT SUBDIVISION _ o <br /> 0 <br /> STRUCTUREJADDITION USE: © o o <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc) Z T <br /> 0 0 <br /> 0 <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 Nona (N). <br /> 2. Show the location of the well (W),septic tank (ST),and drainf laid (OF). 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 i ned and <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. c y <br /> PLOT PLANo n <br /> 401 <br /> x <br /> EG <br /> 4.so� <br /> i M Q1 <br /> 4Z r <br /> B u <br /> (v� F3 SL? <br /> s <br /> / (}J <br /> 1 3 0 ' x 7 0 ° Iw7uTe.kF )i <br /> o <br /> t �Ytov� �yS 1 -DF ; UJ <br /> MInOr 30 <br /> 7V /11^6W.2GS7- <br /> f <br /> O IIL')Q SO fT. 7D Ani% Lor <br /> 60 Lo-0v W L irt%� v s n o 0 <br /> CONDITIONS OF PERMIT: g'm 33 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m Z <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. i i L) '. m <br /> I declare that this application(including an accompanyingschedule has been examined b me and to the best of r11 knowl- - <br /> PP ( 0 Y 1 Y Y <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"' m <br /> tion contained in this application(including any accompanying schedule)and 1 further declare that 1 recognize that t is infor- C <br /> motion 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing i this ap- <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to hav <br /> access to the above described promises at any reasonable time for the purpose of inspection. <br /> SIGN HERE ` I - � <br /> (signature weer or building contractor) _ __.(date) fe` <br /> ZONING ADMINISTRATOR - <br /> ' <br /> TOWNSHIP PERMITS MAY BE REQUIRt � waa -n <br /> o m <br /> 88888888 ai <br />