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Bumett County 7410 Co. Rd. K, No. 102, Siren, W1 548n Office of Zoning Administrator m m o O <br /> APPLICATION FOR - LAND USE - PERMITS f <br /> TO THE ZONING ADMINISTRATOR:The undersigned her app de m <br /> rsig hereby makes application for a Permit for the work described and Q 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 /> m " O <br /> OWNER Mark & Lisa Anderson TELEPHONE o. f <br /> o ' <br /> ADDRESS 2413 150th Street, Luck, WI 54853 g \ <br /> EMERGENCY/FIRE NUMBER ROADNAME South Shore Drive <br /> 01 <br /> LEGAL DESCRIPTION (seetureceipt) <br /> Lot 6, CSM Vol. 14, Pg. 24, T40N, R17W, Town of ion <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION_ p r` <br /> C) <br /> SANITARY $ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION ° <br /> o < <br /> m � <br /> STRUCTURE/ADDITION USE: Sanitary On]-y o 0 <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z <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 Nort (N). <br /> 2. Show the location of the well (VV),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)¢uilding <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 sig ed and <br /> dated by the owner. O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I a m <br /> PLOT PLAN c n <br /> N <br /> O <br /> C ' <br /> 11111 <br /> r <br /> 0 <br /> SEE ATTACHED 0 <br /> 0 <br /> I m <br /> I O y <br /> N <br /> D <br /> I <br /> X'CM� ;0 m <br /> CONDITIONS OF PERMIT: v y,: �C i4 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F o i i -Q ` ` -4 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. - =N: E 33 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. '�" ' im <br /> 11 C <br /> application(including Yaccompanying 1 Y y <br /> I declare that this plication meludin an schedule has been examined b me and to the best of knowl- 31 <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of al inform&- J: " m <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize that his infor- <br /> motion I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue permit. <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized pe n to have 0: <br /> access to the above described premises at any reasonable time for the purpose of inspection. a <br /> m <br /> Wade Rufsholm 6/17/95 <br /> SIGN HERE <br /> (signature of owner or it Ing cont t (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP MITS MAY BE REQUIRED 'M <br /> $$ $$ N <br /> I/ <br />