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r?) (�))71 <br /> Burnett County-7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator ; m o �o <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> 0 <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 '^ <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 m <br /> m <br /> m O <br /> OWNER John MtU!phu TELEPHONE 1612 735-8829 0 v2�) <br /> m <br /> m <br /> ADDRESf999 Nokomis Avenue St. Paul MN 55119 <br /> EMERGENCY/FIRE NUMBER ROAD NAME Pandun Road <br /> LEGAL DESCRIPTION (see tax receipt) Lot 8, CSM Vot. 12, Pg. 90, Sec. 6, T40N R160), Town oU <br /> a. an <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION o <br /> n O <br /> SANITARY x PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> " r <br /> STRUCTURE/ADDITION USE: SanitaAy Onfy ° o 777 <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Z o <br /> O O <br /> N <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 (W),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions infeet of thefollowing:(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. <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. 11 o to <br /> 11 Z Q <br /> PLOT PLAN ° a <br /> m o <br /> C <br /> 0 <br /> SEE ATTACHED — o <br /> C7 <br /> N <br /> o � <br /> ° <br /> z <br /> a <br /> 2 <br /> c m 0 a 0 <br /> m =g � '- am n,m m <br /> aj. z <br /> CONDITIONS OF PERMIT: < _ T.- Z 8 . Q <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. o f 0 : T`z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N: M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. oiit - O <br /> E <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl. o m C <br /> edge and belief it is true,correct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informa- . "'m d' m <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- : ,�' cD g 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 ap- i ,h <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have O N p <br /> access to the above described premises at any reasonable time for the purpose of inspection. T : 3 0 <br /> m A N <br /> N m > : <br /> M : O : <br /> SIGN HERE ,lade RuLsLim - tk(9A10� <br /> (signature of o r or Ing co r on (date) <br /> ZONING ADMINISTRATOR <br /> en`n«tn v,u,wT <br /> TO NSHIP PERMITS MAY BE REQUIRED R. 000 <br /> N N N N m <br /> 0 <br /> 0008080 <br /> rA <br />