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-n c <br /> l <br /> Burnett County 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administrator rn - c 0 <br /> APPLICATION FOR — LAND USE — PERMITS E <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes ° <br /> g by application for a Permit for the work described and � w <br /> located as shown herein. The undersigned agrees that all wont shall be done in accordance with the requirements of the m c <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. w m <br /> 1/7 <br /> 4 m <br /> C <br /> /� / 4 <br /> OWNER 0/ P `C� TELEPHONE _ •_ n 0 <br /> m_ A <br /> ADDRESS1 .'a {.�/vri� 60y✓ <br /> EMERGENCY/FIRE NUMBER V- - 'J ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <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 *C <br /> STRUCTURE/ADDITION USE: C /Q� o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z T <br /> 0 0 <br /> 0 <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). I Dom, <br /> 2. Show the location of the well (W),septic tank (ST),and drainfleld (DF). �S <br /> 3. Show dimensions Infest of thefoilovill(a)building to all lot lines,(b)buildingto center line of road,(c, building -4 <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. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSFFE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 o rn <br /> PLOT PLAN o a <br /> c <br /> I <br /> s <br /> 4 � <br /> L <br /> C <br /> CZ <br /> S <br /> N <br /> m g� ' a m <br /> v $z., ff g.. -.31 <br /> CONDITIONS OF PERMIT: Q S S =8 C <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. c <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ >7 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ' N Q 1 i m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best ofmy knowl- - 0 : <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of II informs- i 4&9 m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize tha this infor- 8 q rn <br /> motion 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 providin in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized pa n to have <br /> access to the above described premises at any rAssall time for the purpose of inspection. i ? 3 `• <br /> m'n V : <br /> M <br /> SIGN HERE t H E <br /> (sign ure of o ner or Ild ntr ton <br /> i if <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED . <br /> «.,««f5+ m <br /> 8ggrn <br /> �88 8888 rn <br />