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Bumeft County 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administrator c m E o <br /> APPLICATION FOR — LAND USE — PERMITS � 3. <br /> m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <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 County Ordinances and the laovs and <br /> regulations of the State of Wisconsin. w m <br /> c <br /> OWNER IDA.i DOP TELEPHONE <br /> I�f I�m <br /> ADDRESS ,6EIJ OSS V• J M`jLL.WAIEL (5g 11N N. _550O Q7— e , <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> I <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR 1111 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING X GARAGE/ACCESSORY STRUCTURE ADDITION vt o <br /> g 0 <br /> SANITARY PRIVY FILLING/GRADING C MPING UNIT SUBDIVISION o <br /> m � <br /> STRUCTURE/ADDMON USE: I r l) o 0 <br /> v <br /> (Home/Cabin;Comm inial Business;Bedroom;Deck;etc.) o 0 <br /> a <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 (NS) and indicate North (N). "1 <br /> 2. Show the location of the well (W),septic tank (ST),and dralnfield (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. Q <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. Q o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE E SUED. 11 3 N <br /> Z c <br /> PLOT PLAN o <br /> M o <br /> C <br /> A s <br /> m <br /> � = <br /> y , <br /> N <br /> O <br /> 7r I� <br /> 6 IIL_V <br /> o r` <br /> v] <br /> O � <br /> N <br /> v IO <br /> c Z <br /> N <br /> >> <br /> m � <br /> Cmgm. o <br /> CONDITIONS OF PERMIT: m 4-'z <br /> $ <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` r" ' Q E ` In <br /> 5 , a <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best oja <br /> 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 informs- r'€ ; i '^m"' T <br /> tion contained in this application(including any accompanying schedule)and I furtherdeclare that I recognize tithis infor-motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issupermit. 1further accept all liability which may be a result of the County of Burnett relying on this information 1 am providiIn this a eplication.I agree to permit county officials charged with administering county ordinances or other authorized pen to have 3 <br /> access to the above described premises at any reasonable time for the purpose of inspection. m )(- <br /> m <br /> m <br /> SIGN HERE <br /> I (date) <br /> sla ZONING ADMINISTRATOR ' '• g <br /> ww Nava m <br /> TOWNSHIP P RMITS MAY BE REQUIRED .v uN N A' N$ <br /> 88 <br /> V8888 w <br />