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Burnett County 741,0 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator UW <br /> APPLICATION FOR - LAND USE - PERMITS <br /> TO THE ZONING ADMINISTRATOR:The undersigned here makes Q ° <br /> Ig by application for a Permit for the work described and a' <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the o 9 <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and <br /> regulations of the State of Wisconsin. o <br /> m m <br /> M O <br /> C <br /> OWNER Tom FaAAe.P,�. <br /> TELEPHONE (715)635-7878 <br /> ADDRESS 2397 County Road A Spooner, WI 54801 <br /> EMERGENCY/FIRE NUMBER ROAD NAME ganoch Road 3 <br /> LEGAL DESCRIPTION (see tax receipt) SWSW, Section 21, T40N, R14W, Town ob Scott <br /> 1 <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION 4-1 p <br /> o <br /> o <br /> SANITARY x PRIPRIVYFILLING/GRADING CAMPING UNIT SUBDIVISION ` —ry <br /> o Q 1 <br /> m 0 <br /> STRUCTURE/ADDITION USE: San-CtahN Ow2y o <br /> g <br /> (Home/Cabin;Commercial Business; Bedroom;Deck;etc.) Zv <br /> 0 0 <br /> 0 <br /> m <br /> 3 <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 (N),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. <br /> 4. H separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and 9 <br /> dated by the owner. O <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. * o m <br /> PLOT PLAN cIN <br /> $ <br /> m <br /> C <br /> to <br /> Uj <br /> SEF ATTACHED <br /> N <br /> 0 <br /> m <br /> O y <br /> w <br /> r <br /> S <br /> N <br /> CONDITIONS OF PERMIT: c a g� B a m g_. 33 <br /> g.- -Q 8 ' ( <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN GO DAYS OF PERMIT ISSUANCE. Z o S'2 <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. e <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. i O '• m <br /> oQe e ; O <br /> 1 declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowl- <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'« ; <br /> tion contained in this application(Including any accompanying schedule)and I further declare that I recognize that this infor- ,i5' B m <br /> motion 1 am providing will be rolled 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 1 am providing in this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have ' <br /> access to the above described promises at any reasonable time for the purpose of Inspection. R7 <br /> m <br /> Wade Ru{)ehoPin �yt�44[? 0M (-sem' <br /> SIGN HERE ` <br /> (signature of owner or building contractor) (date) ! N <br /> ZONING ADMINISTRATOR I I 1 0 iflinAi $ i <br /> MN• NNN�+ <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> 88 $i$$ rm. <br />