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on <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872Office of Zoning Administrator rnZ <br /> 'APPLICATION FOR — LAND USE — PERMITS m m P <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w J <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the m m o <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. 362 <br /> n <br /> 0 <br /> m <br /> m <br /> OWNER Richaxd E Sandna Measnen TELEPHONE n <br /> o <br /> ADDRESS 17391 Pine Lake Road FAedeA2c, WI 54837 9t <br /> EMERGENCY/FIRE NUMBER -AJ <br /> 1739i ROAD NAME pine Lake Rand <br /> LEGAL DESCRIPTION (see tax receipt) <br /> NU! 1/4 SW 1/4, Section 14, T37N, R18W, Town aA Taade L <br /> ahz <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> — o <br /> _ 1 <br /> SANITARY x <br /> PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION r' o <br /> 0 <br /> STRUCTURE/ADDITION USE: <br /> San-Lj'a/LCl (]%ttla o 0 <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) m <br /> Z o <br /> P a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) 9-) .� <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 drainfield (DF). Icc r <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)building to center line of road,(c)building I g <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 and <br /> dated by the owner. <br /> 00 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. <br /> 3 <br /> PLOT PLAN 7�j Z o <br /> M o n <br /> W � <br /> M <br /> 0 <br /> C <br /> 0 <br /> M U. <br /> SEL ATTACHED <br /> J <br /> O <br /> 0 <br /> O <br /> v <br /> I Z <br /> D <br /> r>a0 '9 <br /> CONDITIONS OF PERMIT c 33 v a H e = M <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. = m'o: g Z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. P .0 J j ZM rn <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. ITI <br /> o : : 2 O <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. o g C <br /> am responsible for the detail and accuracy of all informs <br /> edge and belief it is true,correct and complete.I acknowledge that I <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- 8 B g m <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 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 Idv' <br /> access to the above described premises at any reasonable time for the purpose of inspection. m N m <br /> A m i <br /> SIGN HERE_ Ldade Rn4AhcLm o <br /> (signature of owner or building contractor) (date) - e1 <br /> � <br /> 0 : Fv <br /> ZONING ADMINISTRATOR �J)r ` o <br /> 0 i <br /> TOWNSHIP PERMITS MAY BE REQUIRED L" �► N„;„ „ <br /> oN u rn8 ZAm <br /> 0 o g o 0 o N <br />