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97LC IPI <br /> Burnett Cainty 7410 Co. Rd. K, No 102, n, WI 54872 Office of Zoning Adminl0rator S m E o <br /> APPLICATION FOR — LAND USE — PERMITS 3. o <br /> pO <br /> TO THE ZONING ADMINISTRATOR:The undersignedhereby makes application for a Permit for the work descri and � w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirement of the $ <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the la s and <br /> regulations of the State of Wisconsin. w m f <br /> m <br /> Q o <br /> OWNER �IM URB EQ TELEPHONE (o[Z- <br /> ADDRESS OD ssaTr n 5, p� SS '3( u <br /> EMERGENCY/FIRE NUMBER VV`V' �I �1 ROAD NAME <br /> LEGAL DESCRIPTION (seetaxreceipt) <br /> CONTRACTOR <br /> cYl <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> L7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o` o <br /> '^ r <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) o o (� <br /> m <br /> a <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). /� r <br /> 2. Show the location of the well (W),septic tank (ST),and dralydield (DF). " 1 <br /> 3. Show dimensions in feet of thefoliowing:(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 sig ned and M <br /> dated by the owner. C) <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE K SUED. 11 v N <br /> 11 Z Q <br /> PLOT PLAN ° <br /> A ' S <br /> fA o <br /> C <br /> J � <br /> IJ <br /> o <br /> 1 � <br /> nInv< m <br /> W °:`G I s e p c <br /> CONDITIONS OF PERMIT: < H': Z c 8 ?'8 '_ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m'o': Z <br /> P A ' ern. m <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" ' O f ? In <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- : C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of II informs- "'3 "'; T <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize tha this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. i 812 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providin In this ap- ) <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized pe n to have <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> SIGN HERE "" <br /> (date) <br /> VING ADMINISTRATOR <br /> TIW it <br /> MN MMMT+ �l <br /> TOWNSH ERMITS MAY BE REQUIRED N N rn <br /> 8 8888 U) <br /> I� <br />