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6( (6 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m 'o Z <br /> t <br /> APPLICATION FOR — LAND USE — PERMITS 3 <br /> 0 <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and F <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 3 n ��' <br /> regulations of the State of Wisconsin. — o <br /> N d <br /> N � <br /> C <br /> OWNER Earl STruh TELEPHONE 715-689-2832 a Q <br /> ADDRESS 11617N Shore Dr Grantshurg WI 54840 <br /> EMERGENCY/FIRE NUMBER Same ROAD NAME Sante 1 I <br /> LEGAL DESCRIPTION (see tax receipt) NE4SWA S27 T38N R18W Lot 6 & 127 Blk 1 Jensen's lake ") <br /> CONTRACTOR Don Dani.elS ore <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> SANITARY x PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION a o <br /> J <br /> STRUCTURE/ADDITION USE: home, o <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) m <br /> Z o <br /> 0 v <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) v <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). o <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. 0 o m <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 0 0 rn 91 <br /> PLOT PLAN Z Q r— <br /> P o O <br /> m 9 o� <br /> C moi, <br /> to <br /> SEE ATTACHED fA <= <br /> o <br /> n <br /> 0 <br /> N <br /> O <br /> T/� L <br /> ` ` �. <br /> b �_ <br /> � y <br /> i <br /> n cam.> > n of m <br /> CONDITIONS OF PERMIT: c' m N: 42 C S .0 5 M <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m o': 8.z : 1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P f ' ' 21 N <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 1 m <br /> XI <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl <br /> � ' C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- a a n: m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that lois infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o 0 1 <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 N <br /> access to the above described premises at any reasonable time for the purpose of inspection. aOi Pn m <br /> € vR- <br /> A I <br /> SIGN HER 8/8/94 ?????Q-t '" ' " 0 <br /> (signgt(ire f owner or D i ing contractor) (date) 8 <br /> ZONING ADMINISTRATOR <br /> �. . <br /> T <br /> TOWNSHIP PERMITS MAY BE REQUIRED O N o g N m <br /> 000000ppm <br /> 00000000w <br />