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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator v m o 0 <br /> APPLICATION FOR - LAND USE - PERMITS 3" <br /> m m <br /> TO THE ZONING 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 m <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. y m <br /> m � <br /> OWNER Martin F, Rosemarie Proops TELEPHONE61 2-9 3 5-3 5 7 7 <br /> ADDRESS 614 Texas AV. N. , Hopkins, MN 5S343 (Home) �lm <br /> EMERGENCY/FIRE NUMBER (1 lot north of #28306) ROAD NAME 77 <br /> None assigned <br /> LEGAL DESCRIPTION (seetaxreceipt) Lot 2 CSM V 9 P 36 (IN GOV LOT 1) Parcel No. 401623002500 <br /> CONTRACTOR Self <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE X ADDITION p <br /> O <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o 0 <br /> m � <br /> STRUCTURE/ADDITION USE:Stairway between lake and top of hill o <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) Z <br /> 0 0 <br /> 0 <br /> m <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 (MI),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions in feet of the following:(a) building to all lot lines,(b)buildingto 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 and Q? <br /> dated by the owner. 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. Ilia m <br /> c <br /> PLOT PLAN o a <br /> 0 <br /> ism m �3 <br /> M DE T � R(v � <br /> I <br /> S <br /> M <br /> 0 <br /> 0 <br /> qq <br /> Cp�YJo�'(4e� 8F �(✓/P r,1 <br /> �(� W <br /> 4-T09 OF Ht i-t- <br /> f <br /> MARK <br /> � ONNSO Ff{tCaN -WATECL <br /> on - K'� 2 am0 <br /> Qm <br /> Q0 <br /> CONDITIONS OF PERMIT: <br /> M' m N; CS: � 0'5 <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN e0 DAYS OF PERMIT ISSUANCE. om ZQ -i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. £ =y I ' 33 <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. N L7 2 : m <br /> o a IF O <br /> 1 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 informa- .n y a m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor. B p <br /> motion 1 am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. 1 0ig o <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 p <br /> access to the above described premises at any reasonable time for the purpose of inspection. <br /> T 3 0 <br /> A <br /> m v n m <br /> m <br /> O <br /> SIGN HERE OF <br /> (si a ure of o r or building contractor) - "- (date) <br /> ZONING ADMINISTRATOR 110 <br /> N <br /> N N W N 8N m <br /> TOWNSHIP PERMITS MAY BE REQUIRE __ o o+ �n v, O m <br /> 00000000 Co <br />