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&t comp, <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 /> ' m a <br /> TO THE ZONING ADMINIST TOR:The undersigned hereby makes application for a Permit for the work described and m <br /> located as shown herein. The indersigned agrees that all work shall be done in accordance with the requirements of the m <br /> Burnett County Land Use Ordii iance, Sanitation Code, and with all other applicable Country Ordinances and the laws and 3 <br /> regulations of the State of Wisconsin. H <br /> o <br /> w � <br /> c <br /> n O <br /> OWNER Wik2aAd Ubeng TELEPHONE X7151866-7073 f <br /> o <br /> ADDRESS 25840 Ice Hou e BA2d e Rd. WebateA, WI 54893 m <br /> EMERGENCY/FIRE NUMBER 5840 ROAD NAME Ice Houze BAidge Rd. ,I <br /> LEGAL DESCRIPTION (see taxre eipt) NW SE, Section 21, T39N, R77W, Town o Lincofn � <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION p O <br /> n O <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o` ° <br /> J — <br /> '^ r <br /> STRUCTURE/ADDITION USE: SanitaAy Un.bu o <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z <br /> 0 0 <br /> a <br /> m <br /> a <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and sli a of all existing buildings (EB) and all new buildings (NB) and indicate North (N). <br /> 2. Show the location of the ell (W),septic tank (ST), and drainfield (DF). <br /> 3. Show dimensions In feet o the following:(a)building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordin iry high water mark of lake,stream, or river. C <br /> 4. If separate plans are subn itted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSfTE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 1I 3 w <br /> PLOT PLAN Z <br /> 0 o I� <br /> o <br /> C <br /> N <br /> A <br /> n <br /> SEE ATTACHED <br /> o <br /> n <br /> o � <br /> m <br /> I <br /> I z <br /> f <br /> m c Gi r>�+ > f <br /> m <br /> CONDITIONS OF PERMIT: < m Q C 8 .0 Z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. Z m o'i Q <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. o M <br /> 3. NO GRADING OR SHOP LAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o' n : m <br /> € ie : rJ <br /> I declare that this application including any accompanying schedule)has been examined by me and to the best of my knowl- O ! C <br /> edge and belief it is true,torr ct and complete.1 acknowledge that I am responsible for the detail and accuracy of all informa- <br /> tion contained in this applica on(including any accompanying schedule)and I further declare that I recognize that this infor- a S m <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issue a permit. I ': $`li <br /> further accept all liability whir h 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 co inty officials charged with administering county ordinances or other authorized person to have N p <br /> P Y purpose inspection. �t ' 3 g :o <br /> access to the above describe remises at an reasonable time for the ur ose of ins ctl <br /> -_.44 a <br /> SIGN HERE <br /> Wade Ru �sho2rn h , 5/22/54 /� <br /> It ignature of owner or building contractor) (date) <br /> O . ' <br /> ZONING ADMINISTRATOR W Ay 2_ InnA <br /> TOWNSHIP PERMITS MAY BE REQUIRED o8 1W <br /> 8 0 o y <br /> 0 <br />