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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 9 m <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <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 /> m � <br /> /O <br /> OWNER Bob Phetpa TELEPHONE (715)684-3937 0 <br /> ADDRESS Rt. p1 Box 185 M-dw<n, W1 54002 m u1 <br /> 1 <br /> EMERGENCY/FIRE NUMBER ROAD NAME Oak S,tjteeZ <br /> LEGAL DESCRIPTION (see tax receipt) pct SE SE, Section 20, T41N, R16W, Town o{t Sw.ehs <br /> I <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n <br /> SANITARY X PRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> STRUCTURE/ADDITION USE: sanitaay Ono' ° o <br /> v <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z p <br /> so <br /> �/ } <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 drainfiaid (DF). <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building - <br /> measurement to the ordinary high water mark of lake, stream, or river. 0 <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I 3 w <br /> fl Z Q <br /> PLOT PLAN q n <br /> fn <br /> C <br /> m � <br /> f <br /> n <br /> SCE ATTACHED 0 <br /> o In <br /> K. <br /> o � <br /> N <br /> 2 <br /> 1 � <br /> 1 <br /> C <br /> m ii c�ayi mtDi aOZ <br /> m —ErL Q-1 em 3 <br /> m< ,: Ecmos3 <br /> CONDITIONS OF PERMIT: < w 8 0 ro <br /> t. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =r^ 3 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o �g ~' C <br /> $E [ <br /> 3 <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o. !: <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- «. : : G) <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- <br /> : : : i §,� g► C <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infer- 3F <br /> mation 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 in this ap- d, x <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. m 3 bo 9- <br /> 6112/94 w <br /> SIGN HERE Wade Rufihho.Pm <br /> « . <br /> (signature of owner or building contractor) ', ,,, (date) ,. �^ <br /> �m <br /> ZONING ADMINISTRATOR x <br /> TOWNSHIP PERMITS MAY BE REQUIRE �� N Off <br /> �,, - - — — -- <br /> �`_ <br /> � 8 X <br /> - a� X x x x <br /> 0 <br />