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otj C0)/)LP , <br /> Burnett County 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administrator m m e o <br /> APPLICATION FOR — LAND USE — PERMITS . f <br /> m = <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes ° <br /> 9 by application for a Permit for the work described and � w � <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremei its of the m = <br /> Burnett County Land Use Ordinance, Sanitation Code,and with all other applicable County Ordinances and the laws and <br /> regulations of <br /> trhJe OStrate0.wr`Wisconsin. <br /> OWNER m eo OTELEPHONE — 79 , `9CYaYJ <br /> O = <br /> ADDRESSlfqq <br /> QOn S!N'i�Q�l ,t / e a <br /> T A <br /> EMERGENCY/FIRE NUMBER ROAD NAME % / ( _ yk 1 r <br /> w TYJ 1 <br /> LEGAL DESCRIPTION (see tax receipq <br /> CONTRACTOR <br /> l <br /> TYPE OF PERMIT(S): DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ADDITION W o 1 <br /> n O r <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> STRUCTUREJADDITION USE: 4cma E o <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> Z o <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) l Z <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate Nort (N). <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). Imo' 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 If i <br /> measurement to the ordinary high water mark of lake,stream,or river. <br /> 4. H separate plans are submitted by anarchitect,engineer,builder,contractor,etc.,the plans must be sl ned and 0 <br /> dated by the owner. O o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 71 o c 7C <br /> PLOT PLAN c n J� <br /> N_ <br /> O <br /> C 1 <br /> a <br /> re <br /> I�r <br /> o <br /> It7 I11) <br /> k� e C_ k o <br /> ) <br /> ql�'t J S_ Z <br /> I pti �5 <br /> LA) h; rn q{-o v� 1 D <br /> M. <br /> CONDITIONS OF PERMIT: <br /> c m g�z C8 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. N - y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ri, g m <br /> `E ` O <br /> g E 9?fa declare declathat this application(including any accompanying schedule)has been examined by me and to the best of y knowl. ^ : ; <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of al informs- a m�": T <br /> lion contained in this application(including any accompanying schedule)and I further declare that I recognize that is infor. B p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I g�$ 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing I this ap- ' <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized perso I to have ` <br /> access to the above described premises at any reasonable time for the purpose of inspection. QP <br /> SIGN HERE r0 M N <br /> (sign ro of owner or buildin ontracton (date) <br /> ZONING ADMINISTRATOR p <br /> i p i <br /> TOWNSHIP PERMITS MAY BE REQUIRED c v $ N Im <br /> 8888888 Iy <br />