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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator rn v Z r <br /> m m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3IE <br /> 0 <br /> TO THE 'LONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and w <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. - Z o <br /> N d <br /> N � <br /> C <br /> OWNER GaAu WitkeAaon TELEPHONE n f0 <br /> � o <br /> ADDRESS 300 Southda& Ptace3400 Nest 665th. S#iceet Edina, MPI 55435 <br /> EMERGENCY/FIRE NUMBER 27492 ROAD NAME Reitz Rood �J <br /> LEGAL DESCRIPTION (see tax receipt) Lot 4, Stock i , AtbeAt Katbeck1a Subdivibton ori Deviez <br /> CONTRACTOR P- e, Q. alt OWVU� -'CP j <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p —_ <br /> I <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNITa O <br /> SUBDIVISION o 0 <br /> r <br /> STRUCTURE/ADDITION USE: $anitOh GC Un.2l! 0 0 <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) <br /> a Q <br /> or�v` � <br /> 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) O < <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). <br /> 2. Show the location of the well (W),septic tank (ST), and drainfield (DF). O o <br /> 3. Show dimensions infeet ofthefollowing:(a) building to all lot lines,(b)buildingto center line of road,(c)building 1A <br /> measurement to the ordinary high water mark of lake,stream,or river. <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. O o �. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. a <br /> w <br /> PLOT PLAN Z v <br /> l <br /> rn o <br /> C <br /> < <br /> I — <br /> �1 <br /> 1, hj N <br /> w <br /> SES ATTACHED <br /> o <br /> m <br /> o <br /> N � � <br /> t r <br /> f <br /> c�aNir0 a:E <br /> 0 Q. m <br /> CONDITIONS OF PERMIT: c � � <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERM R ISSUANCE. Z m o c C -'1 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. ° f ' '-�rn <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. tl«i In <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 2i i -e C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- «O« <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- i$ a o m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I g'$ 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 n«i <br /> access to the above described premises at any reasonable time for the purpose of inspection. w N <br /> 'o m <br /> m : � A 0 <br /> m <br /> SIGN HERE (9ade Ru7eho4r1 8137192 " § i € <br /> (signature of owner or building contractor) (da .B <br /> Fp, <br /> q o : <br /> ZONING ADMINISTRATOR 6 Z g <br /> « «««« 'I <br /> TOWNSHIP PERMITS 4AY BE REQUIRED v N ra o, N m <br /> .o o oo oobm <br /> 0 0 rA <br />