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COO <br /> Burnett County 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administrator W m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m o <br /> TO rHE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 9 v <br /> located as shown herein. The undersigned 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 Count'Ordinances and the laws and <br /> regulations of the State of Wisconsin. <br /> fP m <br /> OWNER $ f <br /> SAVE ZORrMA4 --/I TELEPHONE �OIZ- 6-7q - 52114 m A <br /> ADDRESS O 7-197- ` D N- O m <br /> EMERGENCY/FIRE NUMBER /,.�Q ROAD NAME i`�A AO,/� goat <br /> LEGAL DESCRIPTION (see tax receipt) "`UUUCCCJJJc� """"""rrr�w��' �i_llll___III Vl <br /> 1 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n L7 <br /> SANITARY _ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> o » <br /> STRUCTURE/ADDITION USE: ° <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z <br /> o ° <br /> o <br /> Q� m <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 drainfleld (DF). Q <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building i <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 9 <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. as a (n <br /> Z Q <br /> PLOT PLAN <br /> � o 0 <br /> w: <br /> C 1 <br /> a � <br /> p7tRCHr-n M <br /> i <br /> 0 <br /> I <br /> 0 <br /> 0 <br /> m <br /> w <br /> » IC) <br /> Z <br /> f <br /> CONDITIONS OF PERMIT: ` c!g ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m I Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p 4 ` rn E <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` r" '• lg G <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best Of my knowl. ! S <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 <br /> tion contained in this application(including any accompanying schedule)and 1 further declare that I recognize that this infor- p <br /> motion I am providing will be rolled 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 1 am providing in this ap• <br /> plication.I 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. r Rq <br /> S- E <br /> SIGN HERE <br /> S <br /> ZONING ADMINISTRATOR ti <br /> TOWNSHIP PERMITS MAY BE REQUIRE AUG _ Q <br /> 88 8$in rn <br />