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Burnett County 7410 . Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administrator vE l ; <br /> APP (CATION FOR - LAND USE - PERMITS m <br /> TO THE ZONING ADMINIS TOR:The undersigned hereby makes application for a Permit for the work described and v a <br /> located as shown herein. Th I undersigned agrees that all work shall be done in accordance with the requirements of the $ <br /> Burnett County Land Use Or linance,Sanitation Code,and with all other applicable County Ordinances and the laws and _ <br /> regulations of the State of Wi oconsin. w m <br /> $ O <br /> OWNER TELEPHONE ti <br /> m m � <br /> o V <br /> ADDRESS S i <br /> EMERGENCY/FIRE NUMBER ROAD NAME d <br /> LEGAL DESCRIPTION (see tax eceipt) <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELL( G/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n L7 <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONS o °< <br /> w r <br /> STRUCTUREIADDITION USE: ° <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o o <br /> 0 <br /> DIRECTIONS FOR PLOT PIAN DRAWING: (Aerial or top view) <br /> 1. Show the location and i Ize of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). <br /> 2. Show the location of th I well (W),septic tank (ST),and dralntield (DF). 2 <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building -q <br /> measurement to the ordinary high water mark of lake,stream,or river. 0 <br /> 4. If separate plans are out milted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 o y <br /> 1A z `c <br /> PLOT PLAN p _ o <br /> LA. <br /> ac,�1PoL ��140 <br /> ISO <br /> N <br /> O <br /> O II <br /> D IL- <br /> O <br /> O � <br /> N <br /> r I� <br /> Z <br /> CONDITIONS OF PERMI Z 9'v ' 'z SQ <br /> C g <br /> 1. DRIVEWAY MUST ME 7 DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTI G OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. e 4 . <br /> 3. NO GRADING OR SH)RELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` r"i '• O <br /> Q . <br /> E 4 i <br /> 1 declare that this applicall n(including any accompanying schedule)has been examined by me and to the best of my knowl• Q <br /> edge and belief it is true,c iffect and complete.I acknowledge that I am responsible for the detail and accuracy of all Informs. <br /> tion contained in this appll stion(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. 1 $ $ <br /> further accept all liability v hlch may be a result of the County of Burnett relying on this information I am providing In this ap• III . <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have <br /> access to the above d*scr bad promises at any reasonable time for the purpose of Inspection. T s <br /> SIGN HERE <br /> (Ngnatun of owner or building contractor) (date) <br /> 8 <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED 'o ' a' 15 pN ra'I6 <br /> 88888888 <br />