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Burns" County 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administrator N�o o" o <br /> APPLICATION FOR — LAND USE — PERMITS s' — <br /> m <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 that all work shall be done in accordance with the requirements of the 0 $ <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 0 <br /> c o <br /> $ O <br /> OWNER6 L.�1q�� z jdu C" TELEPHONE &61,61, <br /> U � m <br /> ADDRESS <br /> EMERGENCY//FIRE NUMBER 7327 ROAD NAME LAl10Y <br /> LEGAL DESCRIPTION (see tax receipt) Yr ^er\j J e 6 L <br /> n L <br /> CONTRACTOR / <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE _ ADDITION�_ O <br /> n L) <br /> SANITARY PRIVY FILLING/GRADING a CAMPING UNIT SUBDIVISION o 0 <br /> - <br /> x r <br /> STRUCTURE/ADDITION USE: _(Hom� inCommP <br /> l a o <br /> Business;Bedroom;Deck;etc.) Z a <br /> o v <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_M,septic to 4 <br /> g.—u-separate plans are suornmeo cry an architect,engineer,al etc.,the plans must be signed and 9 <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1A v N <br /> c <br /> _ Z Cr <br /> PLOT PLAN ° <br /> C Q <br /> a <br /> CX' >`! frv""��{ Serve <br /> 1 N <br /> r\Io <br /> tj <br /> V" <br /> \c 0 <br /> m <br /> 3 1` <br /> - I� <br /> Al 9 0 <br /> 7a <br /> il ) <br /> Qun /U 7-00 C7e � Fir,.p / /G mg� a� y <br /> CONDITIONS OF PERMIT: a H.1 Q c g g ; <br /> I. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. 0 4 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. g ' `• M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. - �' i '• G)25 i m <br /> i Er ' C <br /> I 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- «6 " m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor• <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 it 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 ribed premises any reasonable time for the purpose of inspection. . ; <br /> w w <br /> SIGN HERE 44 J <br /> (gnat ro Owner Ilding contractor) L9 VY/ <br /> ZONING ADMINISTRATOR i i ` g ` i '• <br /> TOWNSHIP P RMITS MAY BE REQUIRED 2 7 orn S Ii '$ m <br /> vmi <br />