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• • W/• p/ <br /> Burnett.County 7410 Co. Rd. K, No. 102, Sinn, W154872 Office of Zoning Adminio trator c m o <br /> APPLICATION FOR - LAND USE - PERMITS . <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work descrit ed and u <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirement 5 of the m = Imo~ <br /> t <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and thelaws and �_ Cy <br /> regulations of the State of Wisconsin. - o <br /> m m <br /> / m <br /> OWNER c I - �-j r� - TELEPHONE <br /> d m_ <br /> ADDRESS �c , r., 4�bjl' I t /O w <br /> EMERGENCY/FIRE NUMBER R AD NAM C1,11- <br /> ( 1 <br /> C1,1 - r ) <br /> LEGAL DESCRIPTION (see tex receipt) (_�- I ' S <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> o <br /> _ <br /> STRUCTURE,/ADDITION USE: o 0 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> o _ <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), o <br /> 3. Show dimensions In feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building .. f <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 sign d and M <br /> dated by the owner. O <br /> 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ED. 'A v <br /> PLOT PLAN z `c <br /> o n <br /> ill /ter, <br /> ^ w <br /> ktac,w C3 J (y) 0 <br /> a � r <br /> M o C; <br /> N <br /> C O <br /> L =(v\ <br /> N <br /> / V <br /> O3. <br /> ^� <br /> m <br /> O y <br /> w 1r <br /> I\1 <br /> z <br /> rn <br /> CONDITIONS OF PERMIT: c m z ? 6 �w g <br /> < ? �+ <br /> XI <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o �w DoZ �8 '83 <br /> 2 .REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _2 y <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. i N It1 <br /> 0 <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. o E E C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all <br /> Informs- <br /> tion "h�' m <br /> contained in this application(including any accompanying schedule)and I further declare that I recognize that thisinfor- 113,L l Q <br /> matlon I 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 int is ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person t have ' <br /> access to the above described premises at any reasonable time for the purpose of inspection. P' <br /> SIGN HERE �' '• fP <br /> (signature of owner or building contractor) e' <br /> o : <br /> ZONING ADMINISTRATOR 8 <br /> TOWNSHIP PERMITS MAY BE REQUIREDN ro« T <br /> oNu, 8f;;"M In <br /> 8 $ $ $88 $8 vi <br />