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Burnett County 7410 Co. Rd. K, No. 102, Sinn, WI 54872 Office of Zoning Administrator in Cm oo <br /> APPLICATION FOR — LAND USE — PERMITS - <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work d U0 described and � <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requireme nts of the <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. m ){J <br /> OWNERTELEPHONE o jv,1 f <br /> Dave and Linda Swanson (612) 949-6012 m a <br /> ADDRESS <br /> 506 17th Ave. N. South St. Paul, MN 55075 <br /> EMERGENCY/FIRE NUMBER ROAD NAME County Road A <br /> LEGAL DESCRIPTION (seetaxreceipt) Dutlot 1, Section 20, T40N, R14W, Town of Scott <br /> CONTRACTOR <br /> TYPE OF PERMIT(S)(-DLING BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p <br /> n O <br /> SANITARY x PRIVY FILLING/GRADING R JCAMPING <br /> UNIT J� SUBDIVISION <br /> STRUCTURE/ADDITION USE: Sanitaryonly 'J lOt1 IPfml 1. C o ° <br /> (Home/Cabin;Commercial Business; Bed om;Deck;etc.) Z v <br /> a o <br /> m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and size of all existing buildings (ES) and all new buildings (NB) and Indicate Noi th (N). <br /> 2. Show the location of the well (N),septic tank (ST),and dralnfield (DF). <br /> 3. Show dimensions In feet of the following:(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. 0 J <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plana must be a gned and 9 <br /> dated by the owner. 0 c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSrrE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. no o rn <br /> PLOT PLAN <br /> Ap <br /> f11 t' <br /> C <br /> a <br /> nl <br /> a <br /> ` G <br /> G r- <br /> SEL ATTACHED 1 <br /> 0 <br /> IN <br /> _ <br /> _ <br /> I� <br /> O y <br /> u <br /> I° <br /> Z <br /> r� <br /> f <br /> g 9 m <br /> w <br /> CONDITIONS OF PERMIT: QCis <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. p ` . S Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ^�„ E G1 yy m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. !t f , ID <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best f my knowl '. <br /> e : e <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy o all informa� �"'�? '. « �+` In <br /> tion contained in this application(Including any accompanying schedule)and 1 further declare that 1 recognize tit it this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issui i a permit. 1 $ $ E <br /> further accept all liability which may be a result of the County of Burnett relying on this information I an providi 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 promises at any reasonable time for the purpose of Inspection. <br /> mT <br /> O <br /> Wade Rufsholm 4/16/55 « ' <br /> SIGN HERE <br /> (signature of ow 11 Ing t t (date) <br /> ZONING ADMINISTRATOR <br /> ✓V <br /> TOWNSHIP PERMITS MAY BE REQUIRED o In <br /> in <br /> �B8 88188 co <br />