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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator rn v z <br /> APPLICATION FOR — LAND USE — PERMITS <br /> f <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes F <br /> located as shown herein. The undo n application i n for r Permit for the work described and v <br /> rsigrted 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 //1 <br /> regulations of the State of Wisconsin. - o � <br /> w m <br /> OWNER612)) 770-5943 ((w)) m m O <br /> DANIEL L. ROSSOW/LINDA D. LEMAy TELEPHONE 612 ) 488-2476 (h) <br /> y J m <br /> ADDRESS g <br /> 295 TOPPING STREET, ST. PAUL, MN 55117 � <br /> EMERGENCY/FIRE NUMBER 28375 ROAD NAME FONTAINE ROAD w <br /> �1 <br /> LEGAL DESCRIPTION (see tau receipt) J <br /> CONTRACTOR <br /> SFT F <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE X ADDITION p <br /> SANITARY PRIVY FILLING/GRADING_ CAMPING UNIT SUBDIVISION o o <br /> _ <br /> STRUCTURE/ADDITION USE: ATTACH CARACF AND J!OSSIBLE CHANGE TO WALKOUT o 4 'F <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) v <br /> z o' <br /> 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). <br /> 2. Show the location of the well (Vi),septic tank (ST),and dralnfield (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. q „ <br /> 4. H separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and �✓ <br /> dated by the owner. e <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED 3 N <br /> PLOT PLAN o a <br /> N M w <br /> C o0 <br /> 00 --Z' 3 <br /> N <br /> ,yn IYRf PI[OP. E"if,S76 PRopotr J <br /> h _ (hNn~' f?fat Cgbl� a �"2 � p�,,,c <br /> � w Ay GAa� I <br /> 3S' �avz <br /> w <br /> rQj <br /> �JocYJ tY' f 6� `�Xca un�d , <br /> Area. <br /> A4 LIMA! I100 <br /> C.Olvd• OFFJ <br /> /O1-ftcl,� <br /> .//�n�WO 5-J S T`b �j m�c;^hchacl s I6e�cle4 <br /> CONDITIONS OF PERMITL3f /c/� rfl�' �C��/dGEG'r 04, ;atz� StUle, O�a:yry'�11,/© �X15TA�w�• a_ ? o .0 ,- <br /> = 3 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE.B� 5/ 2 'o' '-°• : m m <br /> 0 0 . Z : "f <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. JJ /44, Nor f = : _S2 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ',(3s (�/ �, p m <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 >7 <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize that this infor- ; m <br /> motion I am providing will be relied u <br /> D 9 port by the County of Burnett Wisconsin in determining whether to issue a permit. I $ <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 <br /> access to the above described premises at any r!p9nable time for the purpose of inspectior. <br /> -nf i 3 xi <br /> i m v r <br /> SIGN HERE / - 7� /y5 N ' $' <br /> ($I re of owner r uilding contractor) (date) 8 • a i <br /> ZONING ADMINISTRATOR <br /> ✓ Ci f ' H i i i b <br /> j TOWNSHIP PERMITS MAY BE REQUIRED N PPm <br /> $ 8888888 U) <br />