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00C") . <br /> Bumett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator d W o 0 <br /> APPLICATION FOR — LAND USE — PERMITS <br /> o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and 9 w � <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements 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 <br /> w � <br /> c <br /> OWNER BA(an weidendoA¢ TELEPHONE (612( 679-5218 a o <br /> ADDRESS Rt. #1 Box 205 Moaa, MN 55051 i0 <br /> EMERGENCY/FIRE NUMBER ROAD NAME <br /> LEGAL DESCRIPTION (see tax receipt) Lot $, CSM Vol. 13, Pg. 156, Sec. 24, T41N, R 17UJ, Town <br /> 0 U2b-0 <br /> CONTRACTOR � <br /> TYPE OF PERMIT(S): DWELLING/BUILDING_ GARAGEIACCESSORY STRUCTURE ADDITION p <br /> 0 O <br /> SANITARY PRIVY FILLING/GRADING (, AMPIIIJN,(G� UNI SUBDIVISION <br /> SUBDIVISIO/N0 0 <br /> STRUCTURE/ADDITION USE: San2-ta-ty Onty '-+r, I"Id e,., 1 '/UJtt o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z <br /> ° Ua '1 <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). <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. <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 o <br /> NOTE. BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. an3 to <br /> c <br /> PLOT PLAN o a <br /> m o <br /> C i Jn <br /> M (n z <br /> fn � <br /> Su <br /> I C, <br /> o — <br /> SEE ATTACHED I U ti <br /> 0 <br /> O �^ <br /> J <br /> J <br /> O <br /> N_ <br /> n <br /> 1A/ Z <br /> t✓' y <br /> G <br /> o _ ga 20 a 0 a <br /> CONDITIONS OF PERMIT: < m o3. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z d <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P _ = m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. m C <br /> c <br /> 8 ' A a : a <br /> i <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- S : m <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- : Fn m Fn O <br /> tion contained in this application(including any accompanying schedule)and 1 further declare that I recognize that this info"- i N <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I a $ ^ $ <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- a aN <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O u, p <br /> access to the above described premises at any reasonable time for the purpose of inspection. 01 $ iQ <br /> m ' 3 A <br /> Wade Rutahokm 12 ` 8 <br /> SIGN HERE � �' <br /> (signature of owner or building contractor) r <br /> ZONING ADMINISTRATOR <br /> NOV 2 5 1992 <br /> TOWNSHIP PERMITS MAY BE REOUIREDm <br /> " <br /> Nu . P . m <br /> �V( J $ 8 $ $ $ $ w <br />