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Burnett County 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administratorm o o� <br /> APPLICATION FOR — LAND USE — PERMITS s' <br /> m s <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and a <br /> a a <br /> located as shown herein. The undersigned agrees that all work shell 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 <br /> u u <br /> 1 "A O <br /> OWNER " �SS TELEPHONE <br /> Jj <br /> ADDRESS <br /> S 3 r/3'' W rk Ave Sd- <br /> EMERGENCY/FIRE NUMBER Y74S– ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) A e L 's— <br /> CONTRACTOR <br /> TVP PERMI DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> ' o VI <br /> �NITARV PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> �� <br /> m � <br /> TRUCTURE/ADDITION USE: S °— <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z <br /> o <br /> 0 <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 (DF). Q <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 V O <br /> measurement to the ordinary high water mark of lake,stream,or river. i� <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and a <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1A o d to <br /> 1A 2 0 <br /> PLOT PLAN <br /> A o n <br /> AIC <br /> ' Tli <br /> 0 <br /> m <br /> 4 � <br /> E <br /> r IW <br /> 7t:!) r <br /> ?� ;rt <br /> I <br /> F <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. e 'z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ,? ? N m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. , r <br /> L <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- �} , <br /> tion contained in this application(Including any accompanying schedule)and I further declare that 1 recognize that this Inlor• <br /> motion 1 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.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. <br /> M <br /> SIGN HERE <br /> (signature of owner or building contrecto (date) <br /> ZONING ADMINISTRATOR <br /> TOW <br /> NSNIP PER S MAY BE REQUIRED 8 8 �:' <br />