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Burnett Courtly 7410 Co. Rd. K, No. 102, Sinn,WI 54872 Office of Zoning Administrator E c <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and a <br /> m c <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. w m <br /> OWNER ART VANK� /ttM�I�ILAry L�VG)11-n:1'rl TELEPHONE � f <br /> {( o _ ' <br /> ADDRESS <br /> 1013 u31/1- Al• DARRml Owl . 54M <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> I <br /> LEGAL DESCRIPTION (see tax receipt) 4' <br /> I <br /> CONTRACTOR <br /> Irv— <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n O <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> 0 <br /> 1' m r <br /> STRUCTURE/ADDITION USE: {Y(n ��J,V ) J -- ° o <br /> (Home/Cabin;Commercial Business;Bedroom; Dect:etc.) z o <br /> P v n <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). C" <br /> 2. Show the location of the well (W),septic tank (ST),and drainfield (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. Q w <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. - C <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. o m <br /> 1A z v <br /> PLOT PLAN ° o <br /> KR�•�- <br /> c}}-ED <br /> W <br /> 0 <br /> O <br /> 0 <br /> IN <br /> o � <br /> m <br /> r lO <br /> z <br /> I <br /> 1-' <br /> CONDITIONS OF PERMIT: g Q C 8 gNO ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o z ;ij i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. —yg ' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. fn": '• O ` m <br /> hE <br /> -C �E : i 0 <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of my knowl. i E E A <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informs- m <br /> tion contained In this application(including any accompanying schedule)and I further declare that I recognize that this infor. $ p <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 p $ $ <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.I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above described premises at any reasonable time for the purpose of Inspection. T <br /> �i <br /> SIGN HEREIs%Illute @I —4uUtling-con4seton <br /> Ni <br /> (data) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED �Iff;8 m <br />