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cum <br /> Burnett Cf3unty 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator (a I m o to <br /> APPLICATION FOR — LAND USE — PERMITS <br /> m o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v w C <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 m <br /> 90 <br /> OWNER Tom Ketbu TELEPHONE (715) 349-2013 a <br /> o P; <br /> ADDRESS 4878 Bertram Road MXXU Webster, WI 54893 m <br /> EMERGENCY/FIRE NUMBER4878 ROAD NAME Bertram Road o' <br /> i <br /> LEGAL DESCRIPTION (see tax receipt)pct. SE 114, SW 1/4, Sec. 4, T38N, R15W, Town og LaFolte e � <br /> CONTRACTOR ( \ <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p (� <br /> � O <br /> SANITARY PRIVY FILLING/GRADING /-CAMPING UNIT SUBDIVISION ? ° <br /> STRUCTURE/ADDITION USE: Sanitau Onty hdd I�b+7fl <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) Z v <br /> v <br /> m <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 0Q <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 dra(nfield (DF). <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 an <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 -0 <br /> PLOT PLAN o a <br /> f11 N <br /> O <br /> C <br /> w <br /> m � = <br /> I � <br /> 0 <br /> SFE ATTACHED <br /> N <br /> m <br /> ID <br /> v � <br /> N <br /> 31 <br /> ti <br /> C� <br /> G <br /> o c 12 m m e a tt <br /> ° <br /> FL <br /> CONDITIONS <br /> n no m <br /> CONDITIONS OF PERMIT: �; z Co m <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z o u <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. In <br /> b : i a c : i p <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 informs ° ' m�„i m <br /> lion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor >0 E iE m cn <br /> mation I am providing will be relied upon 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 1 am providing in this ap <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to hav w <br /> access to the above described premises at any reasonable time for the purpose of inspection. i m m <br /> -n 3 8 ,c ; <br /> � i i A a . <br /> SIGN HERE Wade Rubzhotm 3/24/93 € : w 8: <br /> i N <br /> (signature of own r bell g con tr to Z date) 8 a <br /> ZONING ADMINISTRATOR ^� x <br /> 8 € <br /> TOW SHIP PERMITS MAY BE REQUIRED o o�" m <br /> 888tmn <br />