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fm term') <br /> Burkett County 7410 Co. Rd. K, No. 102, Sinn,WI 54872 Office of Zoning Adminl for to 'a f1. 1 c <br /> APPLICATION FOR — LAND USE — PERMITS . <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 9 a <br /> located as shown herein. The urWerslgned agrees that all work shall be done in accordance with the requirements of the $ <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. fag_ ! R� v m <br /> m <br /> OWNER &co1 e + OdM (eAj TELEPHONE 7�- _ ) �, a £ <br /> ! /7 -f v � <br /> m_ <br /> ADDRESS A811 -TkF*,k efr 4T / m <br /> eorrrn cQrr%9- XL 60ZPj1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME /�_ Q <br /> LEGAL DESCRIPTION (seetaxreceipt) Pei. �. �, lea ad-40-14 4 lja)�uj 20- y0.-1 I <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING X_ GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> r <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDNISIONc <br /> o <br /> � O <br /> C. <br /> STRUCTURE/ADDITION USE: �4 _ o <br /> (Home/Cabin;Commercial Business; droom;Deck;etc.) Z v <br /> 0 0 <br /> v <br /> 3 <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). I 6 <br /> 3. Show dimensions In feet of thefollowing:(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 M <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE rSSUED. 3 to <br /> PLOT PLAN oAqan <br /> M o <br /> cfia� 0 DQ <br /> II1 <br /> 'C C3go1' <br /> 0 <br /> o <br /> m <br /> m '— nL oR1 <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N'• <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m <br /> PP (including Yaccompanying 1 Y Y <br /> I declare that this application includin an schedule has been examined b me and to the Dost of knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- m T <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that t is infor- 8 p <br /> motion I am Providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 81 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- i i ' <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized person to have - <br /> access to the above described promises at any reasonable time for the purpose of Inspection. <br /> i <br /> SIGN MERE �. <br /> (signature of owner or building contractor) D (date) <br /> i <br /> ZONING ADMINISTRATOR _1111��b'24Cj i rN 0 <br /> 8rr,,i ?Nr�, i <br /> TOWNSHIP PERMITS MAY BE REOUI <br /> N fi�rr,, <br /> N%J o m NO f h N <br /> 888888..8 <br />