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c9-'� 6ZW11--1 <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m m c o <br /> APPLICATION FOR — LAND USE — PERMITS3. 0 <br /> m s <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 3 `� <br /> 0 <br /> regulations of the State of Wisconsin. <br /> o <br /> OWNER Rudo2b So.2omona0n TELEPHONE 17151 689-2163 <br /> ADDRESS 2325 Hanson Lane South St. Pau. , MN 55075 <br /> EMERGENCY/FIRE NUMBER23170 ROADNAME Dunham Lake Road W <br /> LEGAL DESCRIPTION (seetaxreceipt)paAt q Lot 4, CSM V. 1 , P. 65, Sec. 28, T38N, R17w, i <br /> Own of VanleZz Ci <br /> CONTRACTOR O <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> o 0 <br /> 0 <br /> SANITARY x PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION 0 <br /> w r <br /> itaA ° g <br /> STRUCTURE/ADDITION USE: SanN Ont N � 1. <br /> (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) oZ o <br /> o r <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). I r <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. Q <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and <br /> dated by the owner. Q o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I 3 m <br /> 71 z `cr <br /> PLOT PLAN A o a <br /> C I <br /> N <br /> SEE ATTACHED Q _ <br /> 0n <br /> N <br /> 2. <br /> 0 <br /> o � � <br /> n W <br /> Z <br /> Z <br /> A o c m 00 a F m <br /> am a. = � <br /> CONDITIONS OF PERMIT: a = < goo on v, 3 <br /> N N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o F 0 In <br /> _ . N : <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. _ <br /> M <br /> = <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. i O <br /> 8 c : <br /> n � C <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- m mo <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informs- i « m 9i <br /> tion contained in this application(including any accompanying schedule)and I further declare that 1 recognize that this infor- g m g i <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 ap- <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O P' o <br /> access to the above described premises at any reasonable time for the purpose of inspection. 3 8 <br /> A A <br /> 2/10/93 <br /> SIGN HERE wade RuAzhotm I <br /> (signature of oweer or building contractor) (date) <br /> ZONING ADMINISTRATOR10 <br /> �� <br /> TOWNSHIP PERMITS MAY BE REQUIRED `" ^u i o o«S m <br /> $ 88 , 8888ai <br />