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Burnett County 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administratorm' ` m 'o r o <br /> APPLICATION FOR - LAND USE - PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v a g <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 <br /> g <br /> TELEPHONEOWNER 8j-eft7jL <br /> ADDRESS TN e4- 4pr')te I <br /> E <br /> \( I I�IV 1 0 i e <br /> EMERGENCY/FIRE NUMBER ROAD NAME Seg b�� <br /> LEGAL DESCRIPTION (see tau receipt) 4.+ �� <br /> CONTRACTOR 7( b bS— SU r VPA ArX— <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> o` < <br /> w � <br /> STRUCTURE/ADDITION USE: ° o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z o <br /> o c � <br /> m <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 (ST),and drainfleld (DF). <br /> 3. Show dimensions Infect 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. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. o <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. <br /> c <br /> Z o <br /> PLOT PLAN A ° n <br /> M j) o <br /> C <br /> �-ee 4kLc�ch'eO C�srn <br /> P, q-7- L � <br /> I , <br /> ,_I N <br /> rr <br /> 0 <br /> 0 <br /> m <br /> O y <br /> w <br /> Z <br /> tr1:b <br /> 1 <br /> m —g4'2a I fr <br /> CONDITIONS OF PERMIT: <. Z 5 � a ; <br /> I. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. e 5 i it ' <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> Qe <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �' `• O k f ` R <br /> i i C <br /> Lre <br /> I declare that this application(including any accompanying Schedule)has been examined by me and to the best of my knowl- <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- R <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this Info r8 RC <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. $ $ <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.I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described promises at any reasonable time for the purpose of Inspection. .n <br /> M t w i <br /> SIGN HERE <br /> (signature of owner or building contractor) (date) Nq <br /> ZONING ADMINISTRATOR "� � IaC�'(1 E i ' 8 i '• <br /> w wow, <br /> TOWNSHIP PERMITS MAY BE REQUIRED o i' 1X 15 N!D 'f5 it <br /> 8888$ $ 818 <br />