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v, ! I / <br /> Burnett County 7410 Co. Rd. K, No. 102, Sinn,WI 54872 Office of Zoning Administrator ca 5 -af 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 'Z a <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremenis of the <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the]a ws and _ <br /> regulations of the State of Wisconsin. , m <br /> 10, <br /> N } w o <br /> OWNER A /V/ TELEPHONE ,/ ��(' > 30 <br /> ADDRESS / L /J L^ L <br /> EMERGENCY/FIRE NUMBER b ROAD NAME 4-A)4 u C,f- /V E" <br /> LEGAL DESCRIPTION (see tax receipt) - rsm V 3 <br /> CONTRACTOR l/ Ll. 1�', C )C <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> 1 <br /> n G1 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION - o <br /> o <br /> U a <br /> STRUCTURE/ADDITION USE: C AlE- /� U e� '\SOC !� <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z V <br /> 0 0 <br /> n <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 Nort (N). <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to terrier line of road,(c) aullding <br /> measurement to the ordinary high water mark of lake,stream,or river. <br /> 4. H separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sig ed and <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE UED. 7I a y <br /> PLOT PLAN �' r iat (� f ` �- �,eR wl / A) S o c <br /> 1 <br /> See ASG lw( lD«1I// oOlu__,ti �(eUq& fJ/,.s r� <br /> See .S/4�llrf� llc�r� <br /> PS359 <br /> m <br /> C <br /> v <br /> z <br /> I <br /> f <br /> 1 m <br /> e g� Ity <br /> CONDITIONS OF PERMIT: ? fi <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. e f 1'Z 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. u3� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 0 <br /> 5f <br /> I declare that this application(including any accompanying schedule)nes been examined by me and to the best of ny knowl- M <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of a I informs- <br /> tion contained In this application(including any accompanying schedule)and I further declare that 1 recognize that :his infor- <br /> �+a m <br /> p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue 4 peril. I <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing n 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 reasonable time for the purpose of Inspection. p4, <br /> SIGN HERE <br /> (sign re f ownW or bulldin ntractoq (bice <br /> E <br /> ZONING ADMINISTRATOR E 8i ? E <br /> TOWNSHIP PERMITS MAY BE REQUIRE I' ` �� Rd' i5 m <br /> ra <br />