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Crn J <br /> Burnett County 7410 Co. d. K, No. 102, Siren, Will 54872 Office of Zoning Administrator 0 m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <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 '^ <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. H o <br /> c <br /> OWNER NORMAN E PETERSON TELEPHONE 715-488-2625 0 0 <br /> ADDRESS 21099 LAKEWOOD DR GRANTSBURG WI 54840 <br /> EMERGENCY/FIRE NUMBER 910 9 ROAD NAME LAKEWOOD nR =, <br /> LEGAL DESCRIPTION (see taxrec ipt) SE'/4NE'/4 S20 T37N R18W <br /> CONTRACTOR Daniels Plumhina & Heating Inc <br /> TYPE OF PERMIT(S): DWELLINGBUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n <br /> SANITARY X _ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o � <br /> STRUCTURE/ADDITION USE: o <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z o <br /> 0 0 <br /> DIRECTIONS FOR PLOT PLA14 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), g <br /> 3. Show dimensions in feet of hefollowing:(a) building to all lot lines,(b)buildingto center line of road,(c)building 11 <br /> measurement to the ordina 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 signed and A <br /> dated by the owner. Q o <br /> NOTE: BUILDING/STRUCTURE LCKATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 a fn <br /> 11 Z Q <br /> PLOT PLAN ° 0- <br /> SEE <br /> SEE ATTACHED C r <br /> ni U•, � _ <br /> 1 <br /> a <br /> 0 O <br /> O <br /> b <br /> 33 <br /> y <br /> N <br /> JrI, Z <br /> I <br /> G <br /> 2 O_ c N r rDi a <br /> m- 33 — 2.a E m y <br /> N <br /> CONDITIONS OF PERMIT, = < i .z $ r'o <br /> 1. DRIVEWAY MUST MEET I RIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F :ij� - <br /> 2. REMOVAL OR CUTTING F TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ��. _y: M <br /> 3. NO GRADING OR SHORE—AND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 'J.E 32 : : m <br /> o <br /> 13 OE Q <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 1 am responsible for the detail and accuracy of all informs- u m d.: T <br /> tion contained in this application(including any accompanying schddute)and I further declare that I recognize that this infor- B $ ? p <br /> mation I am providing will be 'elied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I $'f3 $ E <br /> further accept all liability Whicl i 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 cou ity officials charged with administering county ordinances or other authorized person to have O p <br /> access to the above described premises at any reasonable time for the purpose of inspection. 'n 3 0 <br /> N m ApA N <br /> M � N O : <br /> SIGN HERE XX-XY 542644 w; <br /> (signature of owner or building contractor) (date) <br /> ZONING ADMINISTRATOR <br /> fH feM+HM�MH TI <br /> TOWNSHIP PERMITS MAY BE REQUIRED o " ro & P"i 2 N m <br /> Inn <br /> 00 <br /> , 0 00000 (a <br />