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OIL Cog <br /> Burnett County 7410 Co. Ri K, No. 102, Sinen, WI 54872 Office of Zoning Administrator V o' o <br /> APPLICATION FOR — LAND USE — PERMITS - <br /> s <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described.�d 9 m <br /> located as shown herein. The urdersigned agrees that all work shall be done in accordance with the requirements of The $ r <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 /> $ O <br /> OWNER �.L�iZ EJ 20 TELEPHONE /- Gam' 6" <br /> un m <br /> ADDRESS _ ).cd <<- <br /> EMERGENCY/FIRE NUMBER ROAD NAME /�' <br /> ) <br /> ✓� y �% y <br /> LEGAL DESCRIPTION (see tax rete pt) s, <br /> r. <br /> CONTRACTOR , � c <br /> TYPE OF PERMIT(S): DWELLING/ UILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo 0 <br /> 0 <br /> IO Xv'10 ( <br /> STRUCTURE/ADDITION USE: > - � 0° <br /> v <br /> Home/Cabin;Commercial Business;Bedroom;Deck;etc.) 0 o G <br /> 0 0 <br /> m <br /> DIRECTIONS FOR PLOT PLAIN, 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 wi II (N),septic tank (ST),and drainfield (DF). <br /> 3. Show dimensions In feet of It is following:(a)building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordinar ir high water mark of lake,stream, or river. <br /> 4. If separate plans are submifted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE 1-01 MUST BE STAN=D FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1A 3 N <br /> _ 1A Z v { <br /> PLOT PLAN O q n IL12 <br /> ? � o` <br /> fci 0i rwa <br /> ON <br /> m <br /> O y <br /> w <br /> J r rl s1 <br /> I <br /> CONDITIONS OF PERMIT: Z o ? 8IC <br /> g <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 <br /> N` <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m <br /> Er ::oe �E : ` C <br /> I declare that this application(I icludIng any accompanying schedule)has been examined by me and to the best of my knowl- 3 <br /> edge and ballet It is true,cori and complete.I acknowledge that I am responsible for the detail and accuracy of all Informs A <br /> tion contained in this applicati n(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be lied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ $ <br /> further accept all liability whiC1 may be a result of the County of Burnett relying on this information 1 am providing in this ap- <br /> plication.1 agree to permit cou Ity 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. .m <br /> a i <br /> SIGN HERE date) « <br /> (sl re of o r or buildifig contractor) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PERMITS MAY BE REQUIRED '8 kX iKr� AA <br /> 88888 i88 w <br />