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BymeH County 7410 Co. Rd. K, No. 102, Sinn, WI 54072 Office of Zoning Admin`Istrator 5 m $ o <br /> APPLICATION FOR — LAND USE — PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work desci ibed and 9 a <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requireme its of the $ , <br /> Burnett County Lard Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. �, m <br /> OWNER TELEPHONE ' O <br /> 866 y/ �3 <br /> a = <br /> ADDRESS Z ,,. ,L.t ,( 6u� 41I. 57 s4 3c. a <br /> EMERGENCY/FIRE NUMBER S[7 Cj ROAD NAME <br /> LEGAL DESCRIPTION (seetaxreceipt) v �' <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> O <br /> SANITARY PRIVY F LING/GRADING CAMPING UNIT SUBDIVISION 0 ° <br /> m � <br /> STRUCTURE/ADDITION USE: F o <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z (n <br /> 0 0 <br /> m o l <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 draiMleld (DF). <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. <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 STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11I v va <br /> • n o 'n <br /> PLOT PLAN �q � �• , � / <br /> P� 0 <br /> e r1r te . Tl` �uc <br /> du�r pw /� e rr / rr� V <br /> 9-) co <br /> co <br /> �.. o <br /> _ <br /> I�1 <br /> m <br /> � gg � Z <br /> ti <br /> S �AGkC> S� (ACL �p¢ir , sed C� [o'rr <br /> e f <br /> 2 � m <br /> e SEL ane nt <br /> CONDITIONS OF PERMIT: _ E. Z & g <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. '_1*_._y' M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r" : O ` m <br /> i <br /> f � ` C <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best f my knowl- o ! : <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy o all informs- «�a•" T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize th t this infor- R B p <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providir g In this ap- <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized Pei son to have O p <br /> access to the above described premises at any reasonable time for the purpose of Inspection. <br /> /� <br /> -7- i r <br /> � w <br /> SIGN HERE�iL/a.� LA qq <br /> V 8 : <br /> (signature of owner or building contractor) (dale) 8 '. <br /> ZONING ADMINISTRATOR I 8 <br /> TOWNSHIP PERMITS MAY BE REQUIRED o u S5 N Nle m <br /> 88888888rn <br />