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Burnett County 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administrator No 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 5 0 — <br /> m <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Z m <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. a m <br /> w � <br /> c <br /> OWNER TELEPHONE $ f <br /> QAa!/qL DAF/S t/d 7/S- 6HS-SOSr{ m <br /> m <br /> ADDRESS z0/ Nia A ST. ,'S.oen.0 ere-. �Wr. 59901 � n <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) S[ yY S W Y S 3 r 39 N Rb14 <br /> CONTRACTOR L✓ONL ,vO�O,p c�OA/S;n*AICr'/OAJ 2/11A 9s ST, egMbEtLAAFCrWG <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT ^(�SUBDIVISION o <br /> STRUCTURE/ADDITION USE: /t o wdr w i-d2 Fa'Etadiad OY-#Ktt, / / ' A L36, <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) +-1� y rt dU t 0 Z <br /> W� 1-- (O ! o o' <br /> m — <br /> a <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 (N),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. C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 71 o y <br /> Z v <br /> PLOT PLAN N�R rev tee t vNE ° n <br /> w <br /> , <br /> 4 10 1 <br /> X 4 0 \ N D m <br /> 0 ° <br /> b 3G'y� A <br /> r ° <br /> o m <br /> O _ <br /> I � <br /> 0.w <br /> 0 <br /> f <br /> 4 <br /> n <br /> m m <br /> CONDITIONS OF PERMIT: �/ �: Z C Q M ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. G =1 <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" C <br /> i i C <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- •+ m <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- 9 rn <br /> mation I am providing will be rolled upon by the County of Burnett Wisconsin in determining whether to issue a permit. I f $ $ <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 premises at any reasonable time for the purpose of inspection. <br /> -n }o¢ <br /> Y i <br /> SIGN HERE <br /> (el •at of ow building contract (date) <br /> ZONING ADMINISTRATOR ` g <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> $ 8888,. <br /> J <br />