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ON CO IED <br /> Burnett County 7410 Co. Rd. K, No. 102, Sinn, WI 54072 Office of Zoning Administrator to m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS <br /> TO THE ZONING ADMINISTRATOR:The u m <br /> ndersigned hereby makes application for a Permit for the work descri d and m c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requireme s of the $ <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the I s and _ i n <br /> regulations of the State of Wisconsin. w m U <br /> w <br /> n O <br /> OWNER S rTELEPHONE £� a = <br /> m <br /> ADDRESS <br /> ' ^^ T I <br /> EMERGENCY/FIRE NUMBER ROAD NAME L- o l ��� d� <br /> LEGAL DESCRIPTION <br /> (see tax receipt) 1 I UA <br /> CONTRACTOR _ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n L) <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> o` <br /> w r <br /> STRUCTURE/ADDITION USE: o g <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z o <br /> 0 v <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 dralydleld (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. 0 , <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE 9 SUED. <br /> 11 Z c <br /> PLOT PLAN 0 � <br /> A <_: <br /> M <br /> C, A*achoL <br /> y� <br /> M <br /> 0) <br /> O <br /> _ <br /> 0 I V <br /> _ <br /> y <br /> w <br /> Z <br /> 'Qmm <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ^�,, �g . m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. k E <br /> ai € L O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. `. O P ; M <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- ' S a 8 m <br /> tion contained In this application(including any accompanying schedule)and I further declare that I recognize thatthis infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue 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 providing in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> 0: Ci: <br /> access to the above described premises at any reasonable time for the purpose of Inspection. ' m <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR rn <br /> T <br /> TOWNSHIP PERMITS MAY BE REQUIREDo 1K 'b o^' ^'n'a"n m <br /> 888885'88 U) <br />