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C71 !�J/ <br /> Burnett County 7410 Co. Rd. K, No. 102, Si an, WI 54072 Office of Zoning Administrator in o 0 0 <br /> �. <br /> APPLICATION FOR — LAND USE — PERMITS m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work descri Ded and m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requiremerts of the m c <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable Courtly Ordinances and the I iws and C� <br /> regulations of the State of Wisconsin. <br /> OWNER W, 8, S4N N DEIZj TELEPHONE C/YJ f <br /> ADDRESS a 6, eoq <br /> EMERGENCY/FIRE NUMBER ROAD NAME aJ <br /> LEGAL DESCRIPTION (see tax receipt) /t1/ML3L� { ns <br /> CONTRACTOR � V I <br /> W <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> c� <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o` � <br /> 57 r o <br /> STRUCTURE/ADDITION USE: = ( ;� <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z V <br /> o ° <br /> a <br /> w <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 Nort i (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 at ned and 9 <br /> dated by the owner. 09 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE UED. 9 v <br /> KErn <br /> Z <br /> PLOT PLV <br /> w U, <br /> 5 a. <br /> 0 m <br /> ,r rn <br /> f0e, ° . <br /> 0.� IL <br /> I <br /> - <br /> 14% �.. <br /> f <br /> g aa� m <br /> § a.m, 70 <br /> CONDITIONS OF PERM ' F <, Z g <br /> 1. DRIVEWAY MUST ME DRIVEWAY WID REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING D VEGETATION IS RESTRICTED ALONG SHORELINE. =N' 21 <br /> 3. NO GRADING OR SHORELA ID ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ' ' i ` O g i m <br /> 4 Q <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- Oi i <br /> , C <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy Of II informa- m"' T <br /> tion contained in this application(Including any accompanying schedule)and 1 further declare that I recognize the this infor- : . B p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 $°� $ <br /> n <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providin ithis ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized part on to have O O <br /> access to the above described promises at any reasonable time for the purpose of inspection. <br /> b <br /> SIGN HERE --- l <br /> (sign re f owner pr Wilding contractor) <br /> ZONING ADMINISTRATOR v t 8 <br /> TOWNSHIP PER ITS MAY BE REQUIRED 2 5 J,««'e«o' m <br /> o � in15N � N� m <br /> 88888888N <br />