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ON COMPUTER/SCANNED <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Adminial ratormr ` o <br /> APPLICATION FOR — LAND USE — PERMITS m g. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work describ4 id and a <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the o c <br /> F <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the la and <br /> regulations of the State of Wisconsin. u m <br /> u e^ <br /> C <br /> OWNER Shawn Dewey TELEPHONE (715)635-3555 o O <br /> m_ <br /> ADDRESS 2830 Augustine Rd. Webster, WI 54893 <br /> EMERGENCY/FIRE NUMBER 2830 ROAD NAME Augustine Road <br /> 1 <br /> LEGAL DESCRIPTION (see tax receipt) pct. SW SE, Section 17, T40N, R14W, Town of Scott <br /> CONTRACTOR 1 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGEIACCESSORY STRUCTURE ADDITION I p <br /> 0 <br /> SANITARY % PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISIONo` ° <br /> '^ r <br /> STRUCTURE/ADDITION USE: Sanitary Only g g <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z <br /> o ° <br /> a <br /> m <br /> a <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 (W),septic tank (ST), and dralydleld (DF). 5 <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)b uIlding <br /> measurement to the ordinary high water mark of lake,stream, or river. C <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sign ad and M <br /> dated by the owner. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAND FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISE4 LED. 11 a <br /> PLOT PLAN o <br /> C o <br /> C ° <br /> a <br /> Ifl <br /> a <br /> SEE ATTACHED <br /> � N <br /> O <br /> O <br /> 0 <br /> d <br /> O y <br /> w <br /> r IO <br /> m XI <br /> I <br /> I <br /> f <br /> 4. w C <br /> CONDITIONS OF PERMIT: �: .Z c$ g <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Q <br /> P � E � � <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. c M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. i r" O X E i p <br /> Er <br /> I declare that this application(Including any accompanying schedule)has been examined by me and to the best of mV knowl- <br /> edge and belief it Is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all nforma- 'r- <br /> «ii�+ • <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that t Is m <br /> infor• f 25 `: m <br /> oration I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issues permit. I 1! E $ $ <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 persor to have ' <br /> access to the above described premises at any reasonable time for the purpose of Inspection. <br /> T i <br /> Wade Rufsholm 4/16/95 « i <br /> SIGN HERE r <br /> (signature of ow r r Ildln t A (date) p( <br /> i b i <br /> ZONING ADMINISTRATOR $! <br /> TOWNSHIP PERMITS MAY BE REQUIRED a 9919g- m <br /> �88�88,88 rn <br />