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� c�� r <br /> Burnett County 7410 Co. Rd. K, No. 102, Sinn, WI 54072 Offfw of Zoning Administrator w m$ <br /> 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 a 4 v <br /> ktcMed 88 Shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the o O <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. <br /> OWNER PAV TELEPHONE 71r <br /> m <br /> m <br /> ADDRESS A-7 c7 <br /> i <br /> EMERGENCY/FIRE NUMBER ROAD NAME �" �-- <br /> LEGAL DESCRIPTION (see ter receipt) �i <br /> CONTRACTOR <br /> t <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p 1 <br /> SANITARY PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISIONo n <br /> o` <. <br /> w 0 <br /> STRUCTURE/ADDITION USE: 0 0 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> a 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 dralntleld (DF). <br /> 3. Show dimensions In feet of thefollowing:(a)building to all lot lines,(b)building to center line of road,( )building - <br /> measurement to the ordinary high water mark of lake,stream,or river. <br /> 4. N separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. UI <br /> NOTE: BUILDINGISTRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I o y <br /> PLOT PLAN <br /> ? o g <br /> in <br /> l `JJ <br /> C> o <br /> f= <br /> 0 M J <br /> o I <br /> m <br /> p y <br /> N �J <br /> `j Z <br /> G <br /> M 8'iny.5? m <br /> CONDITIONS OF PERMIT: ,Z <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z o '' ' 1,2 <br /> PS <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p _ N i 9 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m <br /> 2st D <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best o 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 infonna. p <br /> M <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- E $a <br /> motion 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 maybe a result of the County of Burnett relying on this information I am providin in this ap- <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized pe n to have ` <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> 0 <br /> SIGN HERE G�� <br /> «: <br /> (e gnaturo of owner or building contractor) (date) t <br /> !ONING ADMINISTRATOR U <br /> TOWNSHIP PERMITS MAY BE REOUIRED " ht <br /> 8888$'88'$) <br />