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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator N m 11 0 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. — <br /> 70 THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and m c <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the M m <br /> Burnett CountyLand Use Ordinance, Sanitation Code, and with all other n <br /> applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. <br /> 'v <br /> w � <br /> OWNER 'Van Covey TELEPHONE (715) 689-2317 n <br /> o m <br /> d <br /> ADDRESS 9837 State Road 70 S2Aen, W7 54872 <br /> EMERGENCY/FIRE NUMBER 9837 ROAD NAME state Road 70 <br /> I <br /> LEGAL DESCRIPTION (see tax receipt)pct. NE 114, NE 114 Sec. 20, T38N, R17A/, Town oU Danietz <br /> CONTRACTOR -I <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION v �\ <br /> X lC) <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo l <br /> o < <br /> STRUCTURE/ADDITION USE: SanitytU On2U a <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <br /> 0 0 <br /> v <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) I0_ <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). I� o <br /> 3. Show dimensions infeet ofthefollowing:(a) building to all lot lines,(b)buildingto center line of road,(c)building I� <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. 1I o N <br /> PLOT PLAN Z <br /> n < <br /> m o z <br /> C , �\ <br /> M <br /> i <br /> O_ <br /> 1 <br /> SEE ATTACHED lJ <br /> N <br /> (Y�JJ <br /> o y <br /> N 4� <br /> Z <br /> Z <br /> A ° Nm o d a ran <br /> M <br /> .' m 31 <br /> CONDITIONS OF PERMIT. <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F T yr a <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. m <br /> 1 NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ii; 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 m <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 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. I tU$ $ <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 haveQ O u, p <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 $ R <br /> M A A u <br /> N <br /> SIGN HERE wade RU shoYni - 10/15/92 <br /> a <br /> (signature of owner or building contractor) (date) E x <br /> ZONING ADMINISTRATOR 'a-- <br /> TOWNSHIP PERMITS MAY BE REQUIRED 6 1492 �"`= T <br /> 888 8888m <br />