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Burtatt County 7410 Co. Rd. K, No. 102, Sinn, W154872 Office of Zoning AdminiI111tntor 5 E a <br /> APPLICATION FOR - LAND USE - PERMITS - - <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <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 County Ordinances and the laws and <br /> regulations of the State of Wisconsin. v m n <br /> Y <br /> OWNER EN OR TELEPHONE <br /> ADDRESS ZDBSIE O . ^kBsr'Eiz WI • J' g�3 e , <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> i <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> Y <br /> ii 0 <br /> SANITARY '\ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o` ° <br /> m � <br /> STRUCTURE/ADDITION USE: c <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z o <br /> p o <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). 1 r <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (DF). 2 <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 M V\ <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrrE VERIFICATION BEFORE A PERMIT CAN BE UED. ON a to <br /> 7I Z v <br /> PLOT PLAN ° n <br /> N <br /> C ' <br /> 1Tt I f�at s s <br /> f <br /> N <br /> m <br /> ° <br /> p' <br /> O V <br /> PC <br /> O <br /> lO <br /> I� <br /> 1 L <br /> f <br /> D N V r D£ <br /> cam. m <br /> m. y <br /> CONDITIONS OF PERMIT: a m L <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. p f 5 N '� <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. U1n m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best f my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy 01 all informs- T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize th it inie infer- <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issu a permit. I ) i 1 $°+a 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providir g in this ap- <br /> plication. I agree to pennit county officials charged with administering county ordinances or other authorized pe son to have o i <br /> access to the above described premises at any reasonable time for the purpose of inspection. T <br /> N a : <br /> SKIN HERE <br /> (signature of owner or bulkiing contr t (date) <br /> ZONING ADMINISTRATOR g <br /> -n <br /> TOWNSHIP PERMITS MAY BE REOUIRED IX�8 N N N>5 m <br /> 88t;8888 u) <br /> —_ <br />