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� C07Y . <br /> Burnett County 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administrator to m o 0 <br /> APPLICATION FOR — LAND USE — PERMITSto <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirement of the $ <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable Count'Ordinances and the laws and W <br /> regulations of the State of Wisconsin. w m° <br /> w m <br /> OWNER TELEPHONE <br /> ADDRESS L C d 0 <br /> EMERGENCY/FIRE NUMBER ,J -7 ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWEL ING/BUILDING GARAGE/ACCESSORY STRUCTURE IV/ ADDITION p <br /> � O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONS ° <br /> t1CI 0 <br /> Tip < <br /> t-�1. , <br /> m � <br /> STRUCTURElADDITION USE: 4-WV8 ° <br /> hgl <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z v <br /> o ° <br /> v <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 (yi),septic tank (ST),and drainfield (DF). <br /> 3. Show dimensions In feet of thefollowing:(a)building to all lot lines,(b)building to center line of road,(c)I wilding <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 sig etl and <br /> dated by the owner. C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I o m <br /> PLOT PLAN ? c $ (n <br /> m I_ \ O <br /> a <br /> a <br /> 0 <br /> o <br /> m <br /> Z <br /> I <br /> 90 M0 <br /> F <br /> 2. <br /> CONDITIONS OF PERMIT: a 3: Q cis 8 s ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m I': :221Sto Z : : <br /> E XI <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O c i M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. n 2S m <br /> application(including Yaccompanying 1 Y Y <br /> 1E ' i C <br /> 1 declare that this lication includin an schedule has been examined D me and to the best of knowl- <br /> edge and belief It is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of at I informs- yy!!m M m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that his infor- l5 <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I ? $ $ <br /> further accept all liability which maybe 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 perac n to have O': <br /> access to the above described promises at any reasonable time for the purpose of inspection. <br /> In <br /> m bbb <br /> SIGN HERE���J'-- <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED o b, 8 m <br /> 8888 88'8 M <br />