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Burnett County 7410 Co. Rd. K, No. 102, Sinal, WI 54872 Office of Zoning Administrator m m o c <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work descri and w <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requires' of the m e <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the Is s and $ <br /> regulations of the State of Wisconsin. / a m �1 <br /> OWNER CLE-fEK '1��7pr_I1'1R� f.tC _ TELEPHONE <br /> ADDRESS TrII ft I� Whll DLIV -7 c.' I y/1 A <br /> X23 2Ne 5T- C�4�r�i< W � • 5�1'12�b AV.r. <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) V <br /> I <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n 1� <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> o` < <br /> _ <br /> w STRUCTURE/ADDITION USE: 0 g <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> 0 ° <br /> 0 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) W ` <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 (M),septic tank(ST),and drainfield (DF). 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 <br /> measurement to the ordinary high water mark of lake,stream,or river. III <br /> i <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 g/ <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I o rn <br /> PLOT PLAN n o n <br /> M o <br /> 0 r 0 <br /> tr�}�b in <br /> G <br /> CZ � <br /> C'J o <br /> _ <br /> m <br /> Q y rr <br /> L <br /> 2 <br /> �l <br /> D W-0(a >4d m <br /> =C �. � 80.- <br /> CONDITIONS OF PERMIT: = z c g 8m <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. 0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. (,U �Q' ' �. ` At <br /> �i 0 : <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of y knowl- o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- N a, N m <br /> tion contained in this application(Including any accompanying schedule)and I further declare that 1 recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 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- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have p <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> 3 <br /> m a <br /> SIGN HERE ' « [ <br /> (s (date) li <br /> ZONING ADMINISTRATOR <br /> 1 im RafLiota-a <br /> TOWNSHIP PERMITS MAY BE REQUIRED o Pa 1N'N 8m <br /> 88 8 888 Vmi <br />