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Burnett County 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administristor m 0 o ' a <br /> APPLICATION FOR — LAND USE — PERMITS ' <br /> m o <br /> rO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m c <br /> orated as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the <br /> 3urnett County Lard Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and <br />,egulations of the State of Wisconsin. w m <br /> C m <br /> �7 // -77 0 <br /> DWNER KI ec-4 eI Ve TELEPHONE/('Z Ll 39 " &L93 C) O m <br /> 4DDRESS ROq ttw� m <br /> EMERGENCY/FIRE NUMBER T fd ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) r ,i I <br /> CONTRACTOR /v 1 <br /> 7 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION 1 0 <br /> n O (D <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo °_ <br /> m r <br /> STRUCTURE/ADDITION USE: ° o <br /> v <br /> ome/Ca ' ;Commercial Business;Bedroom;Deck;etc.) o 0 <br /> 0 <br /> } <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 dralnflaid (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 signe d and <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISS ED. 7I 3 rn <br /> z c <br /> PLOT PLAN P <br /> °10 0. <br /> C — <br /> I` <br /> w � <br /> 0 <br /> 0 <br /> O y <br /> 1O� <br /> 2 <br /> , r <br /> R 9 LFE M <br /> 2. <br /> if 33 <br /> CONDITIONS OF PERMIT: <.m ` 'z C '� <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o E ;' �Q ' <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. N' 33 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. rnO G <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 informs- m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor. B O <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I $`2 8 E <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.1 agree to permit county officials charged with administering county ordinances or other authorized personto have 0: 0 <br /> m <br /> access to the above described promises at any reasonable time for the purpose of Inspection. <br /> m o a <br /> m <br /> N N ' <br /> SIGN HERE <br /> (date) <br /> (signature of ow r uil Ing t t <br /> ZONING ADMINISTRATOR ' ' '• $'• <br /> OaNN NNNNT <br /> TOWNS ERMITS MAY BE REQUIRED � u . n u, u,£5 m <br /> 8 8888 U) <br />