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Burnett County 7410 Co. d. K, No. 102, Sinn, WI 54872 Office of Zoning Administrator y (a o <br /> APPLI ATION FOR — LAND USE — PERMITS 5 <br /> m <br /> TO THE ZONING ADMINISTRA R:The undersigned hereby makes application for a Permit for the work described and Q a <br /> located as shown herein. The u rsigned agrees that all work shall be done in accordance with the requirements of the "a $ cia <br /> Burnett County Land Use Ordin nos,Sanitation Code, and with all other applicable County Ordinances and the laws and _ <br /> regulations of the State of Wisco isin. a m <br /> w u <br /> \ p c <br /> TELEPHONE 25 1 — ',C.6 f <br /> a m m <br /> ADDRESS (5 z M <br /> I f nn Pinii ( <br /> EMERGENCY/FIRE NUMBERROAD NAME <br /> 91 7.d <br /> LEGAL DESCRIPTION (see tax rec pt) 4o-if- 3 <br /> CONTRACTOR R'v CAvJ s�(lAC \O� <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION ✓ p <br /> st <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> o` <. <br /> '^ r <br /> STRUCTURE/ADDITION USE: IU lw o ° <br /> Home/ abin;tornmercial Business; Bedroom;Deck;etc.) Z <br /> o ° <br /> a <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). <br /> 2. Show the location of the we It (W),septic tank(ST),and drainflaid (DF). <br /> 3. Show dimensions In feet of file following:(a)building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordinar r high water mark of lake,stream,or river. Q <br /> 4. If separate plans are submit ed by an architect,engineer,builder,contractor,etc.,the plans must be signed and X <br /> dated by the owner. 09 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAID FOR ONSITE VERIFI N BEFORE^A PERMIT CAN BE ISSUED. 1A M m <br /> PLOT PLAN C�� 411111 <br /> Aam oZ <br /> L� 0 )1 °L For ��.� fsfkA/ N so <br /> l <br /> ° <br /> r <br /> ��- wn <br /> ly �( <br /> Z <br /> f <br /> g L'�2- m <br /> CONDITIONS OF PERMIT: v Z;: Z C R- <br /> Q <br /> ; <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z -Q —4 <br /> 2. REMOVAL OR CUTTING O TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ 9 <br /> 3, NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ` �Q' ` OO p <br /> I declare that this application(In luding any accompanying schedule)has been examined by me and to the best of my knowl- g ` ! - <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- E i i N - m <br /> tion contained in this applicatio (Including any accompanying schedule)and I further declare that I recognize that this infor- p <br /> motion I am providing will be n lied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ <br /> further accept all liability which nay be a result of the County of Burnett relying on this information I am providing In this ap- <br /> plication.I agree to permit coun y officials charged with administering county ordinances or other authorized person to have <br /> access to the above described promises at any reasonable time for the purpose of Inspection. <br /> 71 <br /> MMM <br /> SIGN HERE <br /> N: <br /> (al I ref owner or Ing contractor) (date) <br /> ZONING ADMINISTRATOR <br /> N+� TI <br /> TOWNSHIP PERMITS MAY BE REOUIRED 8 8 8 8 81818 H <br />