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ff <br /> Burnett County 7410 Co. Rd. K, No. 102, Sinn,WI 54872 <br /> Office of Zoning Administrator 5 �m V o <br /> APPLICATION FOR — LAND USE — PERMITS m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m c <br /> located as shown herein. The undersigned agrees than all work shall be done in accordance with the requirements of the <br /> Burnett Courcy Land Use Ordinance,Sanitation Cale,and with all other applicable County Ordinances and the laws and �. o O <br /> regulations of the State of Wisconsin. c g <br /> S0 . f <br /> � TELEPHONE m � <br /> OWNER T# I e rka e I V ISN ) <br /> I I ' , n�t/�l�' I ' C u o <br /> ADDRESS �(_.) � N, WI Se /'IV e-- r (, (�/LJ (�� U�� - �- <br /> C! <br /> EMERGENCY/FIRE NUMBER <br /> ROAD NAME <br /> T <br /> LEGAL DESCRIPTION (see tax receipt) <br /> CONTRACTOR <br /> GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> TYPE OF PERMIT(S): DWELLINGIBUILDING o <br /> SANITARY PRIVY FILLING/GRADING <br /> CAMPING UNIT SUBDIVISION oc. <br /> m r <br /> J oZQ�� Gw s�aow o ° P <br /> STRUCTURE/ADDITION USE: cv <br /> (Home/Cabin;Commercial Bus,�ss;Bedroom,Deck,etc.) �,Z7d n o o° <br /> m <br /> 3 1 <br /> -c (o <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). Y <br /> 2. Show the location of the well (VY),septic tank(ST),and dralnfleld (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. C <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and O <br /> dated by the owner. <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. Z n <br /> PLOT PLAN J o <br /> n C I <br /> � IoN <br /> `r pNp <br /> IMP <br /> (0 � <br /> y , r <br /> O <br /> d ` <br /> Z <br /> l � <br /> lO <br /> i; <br /> Mzff i � <br /> v Sal <br /> SQ <br /> IS <br /> CONDITIONS OF PERMIT: 1 �Ji y, <br /> I. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o . <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. a i i � <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. E <br /> In schedule)has been examined by me and to the best of my knowl- <br /> I declare that this application(including any accompanyingthe <br /> wipe and belief it is true,appl <br /> ication onalsanY k�nrw yw0 schedule)and I fthat I am iurtherrdeclare that Iaecognize thatlthis�oe- <br /> tion contained in this will <br /> (including <br /> mation I am Providing will at Wiled upon by the County of Burnett Wisconsin in determining whether to issue •permit. I $ <br /> further plication.1 gree to permiWwu Y officials ala chargrWthe <br /> wlthoadministedng of Burnett <br /> ordinanceson this for other autn I horized person to have - <br /> T <br /> access to the above dsscrl prom"a <br /> at any nnonabis time for the purpose of inspection. . <br /> SIGN HERE ( <br /> ata) <br /> pip u of owner r n contractor) <br /> $ i <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERM 8 MAY BE REQUIRED 8$ 8 <br />