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Bumett County 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administrator (a 0 o <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 2 a <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the o <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. a m <br /> w m <br /> c <br /> OWN E TELEPHONE f <br /> `�'.fD-ac=s � -zs— m A <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME l v' <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> n L7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION —o <0 <br /> _ <br /> '^ r <br /> STRUCTURE/ADDITION USE: L</�LL �ALIs E A,G ,6�t-6.E37�w Sri1E�.@dC o °^ <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <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 North (N). <br /> 2. Show the location of the well (W),septic tank(ST), and drainfield (DF). 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. C <br /> 4. It 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. 1A v <br /> KEm <br /> PLOT PLAN <br /> o <br /> MW v5 = <br /> � I <br /> d UJ <br /> 0 <br /> N <br /> o <br /> w I <br /> n 1� rt <br /> -Z <br /> f <br /> &gym <br /> e. 33 9 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. e <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ? , m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. $ O <br /> 1 declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowl- <br /> edge and belief It Is true,correct and complete.1 acknowledge that 1 am responsible for the detail and accuracy of all informs- « " m <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize that 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 $ $ <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 /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> T <br /> m M : <br /> M <br /> SIGN HER ! « <br /> (al ro 1 owner or it g contractoq (dab) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED ;8 iX 15�' ( $ m <br /> 8 $ 88$ $,818 ai <br />