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Burnett County 74ft Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator It -- 0 <br /> APPLICATION FOR — LAND USE — PERMITS3. M <br /> m a <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and UT <br /> c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the CID <br /> Burnett County Land Use Ordinance,Sanitation Code, and with all other applicable County Ordinances and the laws and 3 n <br /> regulations of the State of Wisconsin. <br /> c <br /> OWNER Tom Lamson TELEPHONE (715)349-2492 a <br /> O ' <br /> m 5 M <br /> ADDRESS 6035 Pike Lake Road <br /> Ulebaten. (uI 54893 , <br /> EMERGENCY/FIRE NUMBER 6035 ROAD NAME Pike Lotze Road <br /> LEGAL DESCRIPTION (see tax race Lot 3 and 20' Lot 4, CSM V.2, Pg. 24, Section 25, T39N tw <br /> CONTRACTOR R16W, Town o{t Meenon <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° r <br /> STRUCTURE/ADDITION USE: Snn,r,tnhu Onhl <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z <br /> v <br /> ho �° <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 (DFw), o_ <br /> 3. Show dimensions infeet of thefollowing:(a) building to all lot lines,(b)buildingto center line of road,(c)building -1 �! <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 M {- <br /> dated by the owner. O o c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSRE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I o m� <br /> PLOT PLAN n o nL• <br /> M , o <br /> ' t <br /> C <br /> Q- <br /> r Cori <br /> SLE ATTACHED <br /> N r <br /> o ) <br /> UA <br /> w <br /> �JJ <br /> T� z <br /> c wS0 c.fm <br /> 7o g' * '-9'°- m a=31 <br /> CONDITIONS OF PERMIT: a Q c roc <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. = m'o'= �Q . 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. o £ =N' <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. Y' : On m <br /> ,� g ai; E C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- �: o m <br /> edge and belief it is true,correct and complete.I acknowledge that 1 am responsible for the detail and accuracy of all informs. «�y.n' m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 oo <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- <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 'oo 0 <br /> a A m <br /> Wade Ru ahotm 3/23/94 ° 0 <br /> SIGN MERE � � � ` = <br /> (signature of wn r or but contractor) (date) <br /> ZONING ADMINISTRATOR1994 <br /> TOWNSHIP PERMITS MAY BE REOUIREP tN N m <br />