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Oil (niW e <br /> .ulmett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ( o 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS d o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v 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. w m <br /> m <br /> OWNER Ralph Lumfey TELEPHONE o U f <br /> m � � <br /> iD <br /> ADDRESS 1875 County Road A Spooner, (UI 54801 <br /> EMERGENCY/FIRE NUMBER 1875 ROAD NAME County Road A <br /> LEGAL DESCRIPTION (seetaxreceipt) NE 1/4 NE 1/4, Sec. 22, T40N, R14W, Town oU Scott, <br /> CONTRACTOR B ucne-tt County <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n O <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o` ° <br /> o <br /> m r <br /> STRUCTURE/ADDITION USE: Sanitahtf Ontbr o' g - <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) z a <br /> Io M <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). r <br /> 2. Show the location of the well (W),septic tank (ST),and drainf laid (DF). <br /> 3. Show dimensions in feet of thefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building CIN <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 M <br /> dated by the owner. 0 S, <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on 3 rn <br /> 7I Z `a <br /> PLOT PLAN <br /> Q o n <br /> 0 m <br /> C , <br /> C� <br /> SEE ATTACHED 9 <br /> o ly✓ <br /> n' <br /> O y <br /> ICJ <br /> Z <br /> �v <br /> . 7 � <br /> mrnvn � aag � <br /> o c . m <br /> m. D$ 31 <br /> $ e o � <br /> CONDITIONS OF PERMIT: Z' Cm Q e o o m 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z <br /> 0 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. >7 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. (1 : Ii m 2 Q <br /> 0.c C <br /> I 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 informa- <br /> tion contained in this application(including an accompanyingschedule)and I further declare that I recognize that this infor- <br /> PP ( 9 Y fl <br /> matlon I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I go 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 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 <br /> access to the above described premises at any reasonable time for the purpose of inspection. P <br /> m 3 E .`• 3 A <br /> m u n m <br /> SIGN HERE Wade Ru�)bhotm 2/10/93 <br /> (signature of owner or building contractor) (dale) : i <br /> )int c g € i <br /> ZONING ADMINISTRATOR Elanigclri_—r : - <br /> TOWNSHIP PERMITS MAY BE REQUIRED L" ~ o o� m <br /> IM <br /> �8 881$888 U) <br />