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Burnett County 7410 Co. Rd. K, No. 102, Sinn, WI 54672 Office of Zoning Adminisjtrator N 9 i = <br /> 5. <br /> APPLICATION FOR — LAND USE — PERMITS m s <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work descrit ad and 9 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 County Ordinances and the Is ws and _ <br /> regulations of the State of Wisconsin. m <br /> u m <br /> c <br /> OWNER oM lJ�T'Q, /,X TELEPHONE f <br /> o ' <br /> ADDRESS IS( Z Rp. S�'oonlFr/Z. WI , a <br /> EMERGENCY/FIRE NUMBER ROAD NAME ^ <br /> LEGAL DESCRIPTION (see tax receipt) l (JjJ <br /> CONTRACTOR �\ � <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> SANITARY <br /> PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o` <br /> n <br /> m � <br /> STRUCTURE/ADDITION USE: S <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> 0 0 <br /> 0 <br /> m <br /> 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) ` <br /> 1. Show the location and size of all existing buildings (ES) and all new buildings (NB) and Indicate North (N). <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (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. <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. a y <br /> PLOT PLAN Z <br /> m o <br /> C <br /> fTCAc{{�j L <br /> o <br /> W <br /> 0 <br /> m <br /> o <br /> N <br /> Z <br /> I <br /> M S'T-o �>DO `0 <br /> 55 E E &I m <br /> m a y <br /> CONDITIONS OF PERMIT: c <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z e I Q i . =jo f <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ a <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. - r" i ' lQ�i E ` m <br /> QQ E X E ` C <br /> 5 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the Desi of my kneel- o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- «m« m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that his infor- ; p <br /> motion 1 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 may be a result of the County of Burnett relying on this information I am providing n this ap- <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized pe n to have <br /> access to the above described premises at any reasonable time for the purpose of Inspection. ' <br /> T71 <br /> i <br /> 7-� ► 1s F <br /> SIGN HERE ' « <br /> (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED «N« «:,«` m <br /> j rn <br /> �^' i � �8 <br /> 88�8888vmi <br />