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L51 <br /> Burnett County 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administrator a f I o <br /> APPLICATION FOR — LAND USE — PERMITS - <br /> m o <br /> TO THE 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 County Ordinances and the laws and _ o <br /> regulations <br /> OWNERS l C /Try-�.-L7 �yV TH sL A l TELEPHONE 7���lO 7(d y✓��v E <br /> b rrtt n /J1o517 f araG(Jse DR, `L � J <br /> ADDRESS rl� %'rr <br /> _ I <br /> EMERGENCY/FIRE NUMBER it 9 ROAD NAME V N!J M 612 , lJ Ir R <br /> [ � C <br /> LEGAL DESCRIPTION (see tax receipt) �-7 <br /> CONTRACTOR N �� �, <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> C <br /> °, <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> STRUCTURE/ADDITION USE: o <br /> v <br /> (Home/ ebin;Commercial Business;Bedroom;Deck;etc.) o c <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 (Sri,and dralrlfield (DIF). ° <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. 11 ` <br /> 4. If separate plans are submitted by an arc Itect,en sneer,builder,contractor,etc.,the plans must be signed and \N <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE V BE F PERMIT CAN BE ISSUED. Z c <br /> o <br /> PLOT PLAN <br /> S'YS/Sf iAE4- I�� C I <br /> ��rt DE.c� 4�' <br /> CA8I C; <br /> j <br /> o <br /> D �1 <br /> If <br /> 6C6wns <br /> l c � <br /> rapt - I <br /> G UNSN� A rrs _ z = g' <br /> CONDITIONS OF PERMIT: _ - SQ ? A <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. p °� to: M <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. In <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. , Q <br /> application(including an accompanyingschedule)has been examined by me and to the best of my knowl- <br /> I declare that this app g Y J <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- e ' m <br /> tion contained In this application(including any accompanying schedule)and I further declare that 1 recognize that this Init. 1 E O <br /> motion I am providing will relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ g i <br /> further accept all liability I may be a result of the y of Burnett relying on this information I am providing In this ap- <br /> plication.1 agree to ps t c n official ch wl inister my ordinances or other authorized person to It ` <br /> access to the above sc Ises Man a lime I the p se of Inspection. m <br /> SIGN HERE 1071-11'x: Q2~tS <br /> ($l at wner or ilding contractor) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERM S MAY BE REQUIRED AL 2 2 8 8 8 8$$lig lg a <br />