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Burnett County 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administrator y m a 1 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> 70 THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and a <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. m 0 <br /> OWNER t, TELEPHONE c £ <br /> ADDRESS �aa Flan K 1 +1 st , Loncnpr VL-- ,I /U o j / � P � CjO <br /> EMERGENCY/FIRE NUMBER �S 4 s ROAD NAME ' I 'L K j�Z� L i I�d- I � ((� <br /> LEGAL DESCRIPTION (see tax receipt) b -7 8 ZA CJ'7A£ MC ✓fin t e-, �j� qc-(-, 1� <br /> CONTRACTOR /�E AA =.�-cyl�r 1 �� <br /> C) <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo <br /> o <br /> m � <br /> STRUCTURE/ADDITION USE: o ° <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z <br /> 0 0 <br /> v <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 (EB) and all new buildings (NB) and Indicate North (N). <br /> 2. Show the location of the well (W),septic tank (ST),and drairlfleld (DIF). i~ <br /> 3. Show dimensions Infest 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. O 3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1A v � <br /> PLOT PLAN .0 'a <br /> �0 <br /> C <br /> 1 <br /> U) <br /> O <br /> 0 <br /> O y <br /> N <br /> I0 <br /> I Z <br /> l �IIIn'Irv� <br /> 1 <br /> F <br /> R �9Fj v <br /> m <br /> o ii� Bae <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. G `z i =j <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. rn <br /> 1 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- E �+ }}-+� m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this Infor- <br /> matlon 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 1 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. <br /> $ <br /> SIGN HERE <br /> (signature <br /> eof owner or building contractor) (data) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED S 9919999 <br /> $ 88888 mm <br />