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NL <br /> Bumgtt County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator W m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m <br /> located as shown herein. The ur dersigned agrees that all work shall be done in accordance with the requirements of the T <br /> Burnett County Land Use Ordina ice,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wiscoi isin. m <br /> c <br /> m O <br /> OWNER Debha SchAoed and RobeA-t li TELEPHONE n £ <br /> o <br /> m 1° <br /> ADDRESS 6988 1 Duck DA<ve Lino Ladk&s, MN 55014 m <br /> EMERGENCY/FIRE NUMBER ROAD NAME SWeOae.A Road t <br /> LEGAL DESCRIPTION (see tax rec pt) W. 61 NE 114, Section 12, T40N, R16W, Town oU <br /> CONTRACTOR UahEand I �- <br /> TYPE OF PERMIT(S): DWELLING/ UILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n O <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o °< <br /> STRUCTURE/ADDITION USE: Sanitmy My o °– <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc-) Z o <br /> 0 0 <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 thew II (W),septic tank (ST), and drainfield (DF). g ( /�I <br /> 3. Show dimensions in feet oftiefollowing:(a) building to all lot lines,i building to center line of road,(c)building 1A h1 <br /> measurement to the ordinary high water mark of lake,stream, or river. C <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. Q o <br /> NOTE, BUILDING/STRUCTURE LO TIONS MUST BE STAKED FOR ONSrTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '11 v m <br /> PLOT PLAN ° ^) <br /> A <br /> C <br /> 111 ' <br /> 1 <br /> I <br /> A— N <br /> m <br /> n <br /> SEE ATTACHED <br /> o I� <br /> o � <br /> N <br /> IT_ <br /> G <br /> Z <br /> I� <br /> N <br /> r�mvr��r�navm <br /> M <br /> CONDITIONS OF PERMIT: < _' Q l S - ' <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. p f �Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =r^' <br /> 3. NO GRADING OR SHORE ND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. r" i O a m <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of 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 informs- ^m MI <br /> tion contained in this applicati in(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be elied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $`Ili <br /> further accept all liability whict may be a result of the County of Burnett relying on this information I am providing in this ap- i <br /> plication.I agree to permit cou ity officials charged with administering county ordinances or other authorized person to have O N v <br /> access to the above described premises at any reasonable time for the purpose of Inspection <br /> Wade u ahotm 5✓ 5/14 " N <br /> SIGN HERE <br /> (si nature of owner or building contractor) <br /> ZONING ADMINISTRATOR �xc E E <br /> iI De: <br /> TOWNSHIP PERMITS MAY BE REQUIRED o cn a �h m <br /> 8 $ 8 8 ai <br /> 0 <br />