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Bunten County 7410 Co. Rd. K, No. 102, Sian, WI 54872 Office of Zoning Admi iatrator Uo c c <br /> APPLICATION FOR — LAND USE — PERMITS . <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Qa <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the require Ms 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. o <br /> u � <br /> ` m <br /> OWNER TELEPHONE a f <br /> ADDRESS fl A Vrr 144, <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (seetureceipt) ` fry ¢ <br /> CONTRACTOR PllleBe,)d G/1 <br /> TYPE OF PERMR(/S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p ro <br /> SANITARY V PRIVY FILLING/GRADING 1CAMPINGG UNIT SUBDIVISION o 0 <br /> STRUCTURE/ADDITION USE: Ca X/ 'f "_5r I I V ) I Rf�L o 0 <br /> (Home/Cabin;Commercial Business; Bedroom;D ;etc.) (r <br /> Z o <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 (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. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 0 <br /> dated by the owner. 0 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMR CAN BE 6SUED. 0 v m <br /> PLOT PLAN n c $ <br /> D c. <br /> I . <br /> � Ru. o <br /> SU lYJ <br /> I <br /> J o <br /> 9 � <br /> N�I <br /> �lv1 I� <br /> ✓V = <br /> I 1) <br /> HH9 m <br /> FL a a <br /> CONDITIONS OF PERMIT: o m 2.: Q c g 1C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. M ; 33 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. O <br /> PP (including Yaccompanying 1 Y Y cp-4 o f C <br /> I declare lost this application rneludin an schedule has been examined b me and to the beat of m knowl- �i o [ � <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- .. H <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize tha this infor- ': S �$ rn <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue permit. I <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providingin 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 /> -n <br /> o <br /> SIGN HERE - w <br /> (signahwof owner or b Id g contr toIr �_� <br /> ZONING ADMINISTRATOR flI <br /> TOWNSNIP P RMITS MAY BE REQUIRED j., 2 4 c 998 <br /> m <br /> gag rn <br />