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Burnett County 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administratorm ; ; o <br /> 5 . ' <br /> APPLICATION FOR — LAND USE — PERMITS m Io <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 9 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. m m <br /> . � A _ OOWNER TELEPHONE > rl -Z ` ' � I-L E <br /> 0 <br /> ADDRESS l� �S v� �� S- !/r���`- e 1 V <br /> EMERGENCY/FIRE NUMBER �]/ ROAD NAME /�v� Xl <br /> LEGAL DESCRIPTION (see tax receipq /IV'CCC- ��// <��� <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 /> STRUCTURE/ADDITION USE: � <br /> 0 <br /> (Home/Cabin;Commercial Business;Bedroom Deck;etc.) Z o �_ <br /> o v <br /> } <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 (Vi),septic tank (ST), and drainfield (DF). .°r. <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building 7I <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. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 o m <br /> 1A Z Q <br /> PLOT PLAN <br /> m <br /> ,4Mf -o? LJevt oft- W/1 r F,< 111 <br /> I <br /> 1� <br /> Z <br /> N <br /> 3, <br /> i s <br /> G� <br /> m <br /> APIZ�x. <br /> ASO Y2D1 -�� <br /> s <br /> Z$ C{ 1 tJ Z <br /> V'-- 3o x <br /> /G ? af R"y 1 <br /> I '. f <br /> R Lo T <br /> XICONDITIONS OF PERMIT: o ego Z': Z C ' ; <br /> Z eb'E �.Z ; �1 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN fi0 DAYS OF PERMIT ISSUANCE. p � _ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. (n• ' 21 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. - �' i '• k5gk ': rn <br /> 4Y �E ' C <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowl- S M '- 9 <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- Y!? m <br /> tion contained in this application(including any accompanying schedule)end I further declare that I recognize that this infor• i5 <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 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.1 agree to permit county officials char ed with administering county ordinances or other authorized person to have <br /> access to the described pre s at roes Is time for the purpose of Inspection. -n <br /> SIGN HERE <br /> gn re f owner ding contractor) 2 (QlrolFt�J <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED JUL 2 21994 <br /> C( I� Sem g-aa ay <br />