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e7l tp <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 office of Zoning Administrator a a <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 <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 n <br /> regulations of the State of Wisconsin. w <br /> c <br /> n O <br /> OWNER Wesley Nicholson TELEPHONE 612-535-6861 <br /> m <br /> ADDRESS 5426 Scott Ave N Crystal MN 5542.9 <br /> EMERGENCY/FIRE NUMBER 29401 ROAD NAME County Rd "H" <br /> LEGAL DESCRIPTION (see tax receipt) GI. 4 S4 T40N R14W Lot 8 LL <br /> CONTRACTOR Donald Daniels 9 <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE_ ADDITION o <br /> n 0 T. <br /> SANITARY Y� PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> r <br /> STRUCTURE/ADDITION USE: ° o <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z <br /> o a <br /> m <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). <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordinary 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 M <br /> dated by the owner. C o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSffE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. '1 5 cn <br /> 71 Z <br /> PLOT PLAN L7 ° n <br /> M y <br /> See attached N <br /> M � IJ <br /> I <br /> n_ <br /> 0 <br /> N <br /> O _N <br /> ° (N <br /> 1 <br /> b <br /> C7 y <br /> N <br /> 0. <br /> y 0 <br /> 111 m MM <br /> CONDITIONS OF PERMIT: < h' Q g 8 ro <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o m 0 : T`z -i <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =y <br /> �: <br /> jo <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. - 8 : iii0E m <br /> $' m C <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- o - <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- «y« m <br /> lion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- `� cl 8 ; p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I <br /> further accept all liability which may be a result of the County of Burnett relying on this information I am providing in this so- N <br /> plication.1 agree to permit county officials charged with administering county ordinances or other authorized person to have O <br /> access to the above described prre'm�ises�atan�y reasonable time for the purpose of inspection. m 3 c� <br /> GL'Y'f/�'LCGGJ� <br /> o <br /> SIGN HERE m <br /> 9/22/93 « w G^^'"r' <br /> (signature of owner or b ' g co tractor) (date) <br /> ZONING ADMINISTRATOR g <br /> « ««d « m <br /> TOWNSHIP ERMITS MAY BE REQUIRED 'o ^ a N <br /> rn <br /> �$ 8 on <br />