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Burnett County 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administrator (/ I m / <br /> APPLICATION FOR — LAND USE — PERMITS - 10E P <br /> TO THE ZONING ADMINISTRATOR:The undersigned he Q = <br /> rtdersig hereby makes application for a Permit for the work descr bed and m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremef its of the o c <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the aws and 5. ?L <br /> regulations of the State of Wisconsin. w m <br /> l <br /> OWNER / S. TELEPHONE <br /> m m <br /> ADDRESS �'/ - <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> yl <br /> LEGAL DESCRIPTION (sae tex recaipt),C3 V 3 ISO _ -140-1 S <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o` = <br /> = n <br /> n " r <br /> STRUCTURE/ADDITION USE: e, rk A- Q e K- CJ D-e-e k o ° <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) <br /> Z o <br /> o c <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 Nort N (N). <br /> 2. Show the location of the well (YI),septic tank (ST), and drainfield (DF). <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. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. IN a N <br /> I ? C <br /> PLOT PLAN Z <br /> S T4 P,GN e � A o n <br /> O <br /> o o S�R-e e�1 o <br /> d',0- C- <br /> fn C� <br /> l <br /> qNq <br /> 0 O <br /> S,� seretN O�,> dti - 0 R► <br /> OP <br /> a Ivc)fi e X/e4?g;7( <br /> 0 <br /> >o = <br /> i <br /> 2. m <br /> m g� 6 <br /> CONDITIONS OF PERMIT: 3. z 6 c x m g'r8S <br /> _ = ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z 8,2 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. c >7 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Zvi i m <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 61 informs- <br /> tion contained In this application(including any accompanying schedule)and I further declare that I recognize that this Infor• <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue 11 permit. I $ $ <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing It this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized ps n to have ' <br /> access to the above described premises at any reawnable time for the purpose of Inspection. 7RgF <br /> SIGN HERE <br /> (sign n owner or inq eomraetoA (date) bt ; <br /> ZONING ADMINISTRATOR I ', Oa 18 102. 8 <br /> TOWNSHIP PERMITS MAY BE REQUIRED L� '__ ___ g( Ijg m <br /> 888888'88w <br /> s <br />