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Burnett County 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administrator U1 l o <br /> APPLICATION FOR — LAND USE — PERMITS ' <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v a <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. <br /> 1 C m o <br /> TI-�IC `I lC boi�, TELEPHONE �y�� 353 / <br /> OWNER J_ e0AjC'.A+ I((�� QIUm m <br /> ADDRESS r7DI- I d ?I"I(��Sf' i 8 S �L %D dJ 1 <br /> EMERGENCY/FIRE NUMBER J q 9 y9 ROAD NAME � II <br /> LEGAL DESCRIPTION (see tex receipt) L-ef- 5 711'1a -8/0 ^ <br /> CONTRACTOR e 3— <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE r'}' ADDITION o r <br /> -T n L1 <br /> SANITARY PRIVY FILLING/GRADINGr/) CAMPING UNIT SUBDIVISION o <br /> i'r <br /> STRUCTURE/ADDITION USE: o <br /> c <br /> (Home/Cabh ,Commercial Business;Bedroom;Deck;etc.) o 0 <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 (W),septic tank(ST),and dralnfield (DIF). I ° <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. 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. Q <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. <br /> Z v <br /> PLOT PLAN A ° <. <br /> lane M <br /> G'ranberr P C <br /> ar M 1 <br /> � I <br /> 0 0 <br /> c� <br /> o <br /> 11 Ao <br /> ~r <br /> I <br /> +19✓ 710 = <br /> t <br /> 9> <br /> �b•�' s ����� pg <br /> $•� ''ae '"1 m <br /> m _ y <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 AVS OF PERMIT ISSUA E. a �'Z '• q <br /> I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED LONG SHORELINE. ^ ' 3 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS PECIFICALLY PERM ; <br /> ITTE .�/0 �' ` ` m <br /> Or <br /> I declare that this application(including any accompanying schedule)has bee examined by me and to a best of my kni wl- O i S , ra <br /> saps and belief It Is true,comet and complete.1 acknowledge that I am respon Ible for the detail and uraoy of alt holo a- <br /> tlon contained In this application(Including any accompanying schedule)and I f r declare that 1 gnus that this 1 or- f R 8 E p <br /> motion I am providing will be oiled upon by the County of Burnett Wlseon$I in de ning wheth r o issue•W t. I $ $ <br /> further accept all liability which may be a result of the County of Burnett relying on this info Ohl providing to this ap- <br /> plication.1 agree to permit county officials charged with administering county ordinances or oth rized person to I a <br /> access to the above described promises at am reasonable time for the Durpo f inspection. r ; <br /> E <br /> SIGN HERE <br /> (elgnstu ner r Ilding contractor) (date) u <br /> i <br /> N i 8 <br /> ZONING ADMINISTRATOR b : i : N• i so <br /> TOWNSHIP PERMITS MAY BE REOUIRED m <br /> 8888888!8 ) <br />