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C�/n <br /> R�Imett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator /f £ ° <br /> APPLICATION FOR - LAND USE - PERMITS m <br /> TO THE 20t4ING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and � <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. m m <br /> E <br /> OWNER MChCzVl $Q.ttJ� TELEPHONE (715( 349-7232 a _ <br /> O m <br /> m <br /> ADDRESS Rt, #2 Box 340 Webe-ten,W1 54893 = `�- <br /> EMERGENCY/FIRE NUMBER 24849 Kaugen Road ROAD NAME KAugen. Road 1, '" S <br /> LEGAL DESCRIPTION (seetaxreceipt) Lot 8, Malt Lee AVIS, Section 33, T39M, R1 601, Tow;2 0�1 I <br /> Pleenon <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> � O <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> '^ r <br /> STRUCTURE/ADDITION USE: Sancta✓rr_r Jnksr ° °• <br /> v <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) o <br /> v <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). IJ r <br /> 2. Show the location of the well (W),septic tank (ST),and drainfieid (DF). _p ° <br /> 3. Show dimensions in feet ofthefollowing:(a)buildingto 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. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. Q o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. on 3 N <br /> '7I Z c <br /> PLOT PLAN p <br /> M Io S <br /> C <br /> M � <br /> O <br /> G Y <br /> n <br /> SEE ATTACHED <br /> Cj O <br /> 0 <br /> ° <br /> ° <br /> m <br /> Z <br /> s <br /> DEC 1 01992 ' <br /> A o c � N r D ➢ p er <br /> ao. N a1. M <br /> cH o 3 <br /> CONDITIONS OF PERMIT: o 0 ° m a <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. = N i m <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. off <br /> $ c : <br /> n C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- y! m w <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor i 15 m N <br /> mation I am providing Will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $ m $ <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 O v, o <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 8 8 <br /> H N A N <br /> 12/9/92 <br /> SIGN HERE i ` H n <br /> (signs re f owner orb ' g contractor) (date) x <br /> o : <br /> ZONING ADMINISTRATOR gi ' <br /> TOWNSHIP PERM S MAY BE REQUIRED <br /> i"niX 000 m <br /> 88 $ $ 8 $ 88rmn <br />