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/Bumett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS3. <br /> W ° <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and v w <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. <br /> c <br /> m o <br /> OWNER Dake AndeA.6on TELEPHONE (715) 488-2793 <br /> ADDRESS 12150 MY Road GAant.sbuA g, WI 54840 <br /> EMERGENCY/FIRE NUMBER 12150 M-Y ROAD NAME M-Y Road C <br /> LEGAL DESCRIPTION (see tax receipt) I VJ <br /> sw SW, Section 4, T37N, R18W, Town o� 7Aade Labe J <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n o <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o <br /> STRUCTURE/ADDITION USE: CrvtitaAy O�nZy <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) z o <br /> 0 0 <br /> m <br /> 3 <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 drainfield (DF). <br /> 3. Show dimensions in feet ofthefollowing:(a) buildingto all lot lines,(b)building to center line of road,(c)building q <br /> measurement to the ordinary high water mark of lake,stream, or river. 6 J <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and hr <br /> dated by the owner. p o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 7I 3 cn <br /> �I z <br /> PLOT PLAN <br /> m o <br /> c ( ' <br /> m � - <br /> Its N <br /> O <br /> ' <br /> SEE ATTACHED I� <br /> o <br /> N <br /> Z <br /> A in-0 Def -0 rn <br /> In <br /> CONDITIONS OF PERMIT: < ; C 8 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F ' zii'z i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =r^ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �' m <br /> $ @ C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- : m 9 <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informa- d'm is; T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- i `a S <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 Count of Burnett relying on this information I am providing In this a - 6 <br /> o : <br /> P Y Y Y Y 9 P fl� Fn <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O N o <br /> access to the above described premises at any reasonable time for the purpose of inspection. T 3 0 <br /> om m n w <br /> ade RuSeGo'r 10/6/93 <br /> SIGN HERE ` '^ <br /> (signature of owner or buildin r (date) <br /> ZONING ADMINISTRATOR <br /> TOWNSHIP PER ITS MAY BE REQUIRED o N N m <br /> $ $ $ ° $$ $ fmA <br />