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Burnett Coanty 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administrator 0 m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS m s <br /> FLA <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work descri and m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirement of the 0 <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the Is sand l n <br /> regulations of the State of Wisconsin. N m ll <br /> w m <br /> c O <br /> OWNER CHS>Ch TELEPHONE <br /> ADDRESS <br /> EMERGENCY/FIRE NUMBER ROAD NAME ELL/OT To NnJS .v <br /> LEGAL DESCRIPTION (see tax receipt) LCT /;z t"Y' /0.06.c /9S- v- 199 60[• s.pT V <br /> S AI - JIF <br /> CONTRACTOR -L .I <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> L7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o` <br /> ����TTT ,J .3 <br /> STRUCTURE/ADDITION USE: � U M 4ll�i �-i r=fi �+1��(J �r�ll-t �• o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z <br /> 3 'II\J <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 (Vi),septic tank (ST), and drainfield (DF). <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. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 t t <br /> dated by the owner. 0 j1j <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I o m <br /> PLOT PLAN o S <br /> C <br /> N <br /> cr <br /> f8 <br /> 332, 91 so <br /> T <br /> 1-2y, <br /> o <br /> 0 <br /> -50 <br /> [ la 9y,7'icN /yS[20 f 3c nRcnm 3a1N <br /> . I z <br /> VIL. a <br /> 3Y/, 3 <br /> IFN I <br /> a. 77 g� $am a0 <br /> CONDITIONS OF PERMIT: Z o 3.: <br /> ? Z g ? m— <br /> t. 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. a ° to33 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. !^ O m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my know,- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- E NN m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that his infor- p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue mi permit. I <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing iiin this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have 0 0 <br /> access to the above described promisee at any re nable time for the purpose of inspection. v <br /> In 0 <br /> SIGN HERE <br /> N: <br /> (signaturo of owner or building contractoq " (date) <br /> ZONING ADMINISTRATOR l Int r If�^ 1E 8 E <br /> NN+�NNN+ -t <br /> TOWNSHIP PERMITS MAY BE REQUIRED 'o $ $N (n uN,8 m <br /> 08888888w <br />