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ON COMPUTER/SCANNED <br /> Burnett County 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administrator <br /> APPLICATION FOR — LAND USE — PERMITS m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 9 <br /> Iocatbd as Shown herein. The undersigned gees 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. m <br /> O <br /> OWNER -� y/ TELEPH0 <br /> In <br /> ° <br /> ADDRESS .Ir�IL� 2 GCX Z� <br /> <�1 Uj <br /> EMERGENCY/FIRE NUMBER —Sc e--ET Z(�at� V {y,ROADNAME <br /> LEGAL DESCRIPTION (see tax receipt)(OT //�A - S"t O'n L k /, 1 7 2 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION O <br /> n L) <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> SUBDIVISIOON o °< <br /> �/ a 1 / <br /> � <br /> STRUCTURE/ADDITION USE: �a � // G/�` <br /> (Home/Cabin;Com ercial Business; edroom;Deck;etc.) o 0 <br /> 0 <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 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. 0 <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 STARED FOR ONSTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. a to — <br /> y�Q � � c <br /> PLOT PLAN ��+, 1� �+^ i(.ii.l�Y .CL- Cp,vo Q.,4� o n <br /> n n <br /> GZ v Z� y o R Meilju <br /> 00NJ'6W5 aryY1" D <br /> N <br /> /Der:. TD be All 4;70A to Mee+ <br /> /i't 17+rt�d-� PCLTIO wG 0 <br /> O <br /> -- I)ft 4y W-t Qbou e �'r-owrj 61 i � 2j <br /> 3) pAeT, lo � c�o- -ro = I� <br /> :g4de lot iii cs �w e-901�^k d <br /> z <br /> CAbr� , <br /> S 4 - a <br /> CONDIT NS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r^ '• O gg i G <br /> 25 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the beat of my know[' <br /> m <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informs- m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this Infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I r-: I $ $ <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 abol described promises at any reasonable time for the purpose of Inspection. ,m <br /> w <br /> SIGN HEREr� �"• <br /> (sign a*low r building contractor) `- = (4 b <br /> I l�, <br /> ZONING ADMNISTRATOR <br /> ^ li54KA �S m <br /> TOWNSHIP PERMITS MAY BE REQUIRE o <br /> 888888'88 to <br />