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/ <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator U m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> 0 <br /> TO THE ZONINL 1AMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and c <br /> located as shown main. 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. "' 0 <br /> N d_ <br /> OWhenfeen TELEPHONE o FO <br /> NER Calif GAa <br /> h (715) 866-7973 m <br /> ADDRESS 6247 Petehbon Road WebsteA, CJI 54893 m <br /> EMERGENCY/FIRE NUMBER 6247 ROADNAME PefeAson Road O <br /> LEGAL DESCRIPTION (see lax receipt) <br /> yetip. NE NF, Section 26, T39N R16W TaUm_ o � Meenan L <br /> I <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p W <br /> M <br /> C) <br /> SANITARY X _ PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o ° <br /> '^ r <br /> STRUCTURE/ADDITION USE: SCnitaAy On2U o ° <br /> (Home/Cabin;Commercial Business;Bedroom; Deck;etc.) <br /> Z o <br /> 0 0 <br /> ct— <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). J <br /> 2. Show the location of the well (W),septic tank (ST), and dralnffeld (DF). <br /> 3. Show dimensions in feet of the following:(a)building to all lot lines,(b)buildingto center line of road,(c)building - 11j <br /> measurement to the ordinary high water mark of lake,stream, or river. ILq <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. n <br /> 0 m <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 3 ur <br /> PLOT PLAN Z <br /> C m� o <br /> a � <br /> M UJ - <br /> z <br /> i <br /> o <br /> 0 0 <br /> J <br /> Si=F ATTACHED m �" <br /> v � <br /> n <br /> O <br /> /� <br /> 0/41 c � <br /> 4 , s <br /> D �W 11 fn r'DDO 'D <br /> m —$� 2. <br /> - " Qm n <br /> am m <br /> CONDITIONS OF PERMIT: a m y. Q <br /> CS pro M <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o <br /> M <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. y' M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. �^ : 2 m <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- 0 <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of all informa- H a n: m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- I o ; p <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I o'$ o <br /> OE i 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 N o' <br /> access to the above described premises at any reasonable time for the purpose of inspection. : m o m <br /> 3o0cS <br /> SIGN HERE Jade Ru44hopm 10/13/93 <br /> (signature of owner or b i co r tor) (date) I " ` .9 ' <br /> q o FI; [ <br /> ZONING ADMINISTRATOR 4 <br /> 8 <br /> +HMd1(H n <br /> TOWNSHIP P RMITS MAY BE REQUIRED ____ o N N N N m <br /> . o � 000 in <br />