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Burnett County 7410 Co. Rd. K, No. 102, Siren, WI 54872 Office of Zoning Administrator m Jo' o <br /> APPLICATION FOR — LAND USE — PERMITS3_ —_ <br /> d o <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and <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 Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and 3 a <br /> regulations of the State of Wisconsin. m <br /> N � <br /> C <br /> m p <br /> OWNER AAte.n and Linvet Jensen TELEPHONE (715)463-5847 a £ <br /> o ' <br /> ADDRESS V.U. BOX 625 Gnant,sbwtg, wI 54840 — <br /> EMERGENCY/FIRE NUMBER ROAD NAME No2th Road -� <br /> LEGAL DESCRIPTION (seetaxre eipt) E 112 NW 114 SE 114, Section 18, T38N, R18w, TOWn ole 1 <br /> Wood kveA <br /> CONTRACTOR <br /> TYPE OF PERMIT(S): DWELLING/BUILDING GARAGE/ACCESSORY STRUCTURE ADDITION <br /> O (V <br /> SANITARY X PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION <br /> _ o <br /> m r V <br /> STRUCTURE/ADDITION USE: ,anitaAy Onh! o <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) Z <br /> 0 0 <br /> a <br /> DIRECTIONS FOR PLOT PLAIN DRAWING: (Aerial or top view) <br /> 1. Show the location and sl a of all existing buildings (EB) and all new buildings (NB) and Indicate North (N). <br /> 2. Show the location of the i veil (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 -4 <br /> measurement to the ordinary high water mark of lake,stream,or river. <br /> 4. If separate plans are subry itted by an architect,engineer,builder,contractor,etc.,the plans must be signed and M <br /> dated by the owner. <br /> 00 <br /> NOTE: BUILDING/STRUCTURE LCCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. 11 c rn <br /> tl Z <br /> PLOT PLAN 0 <br /> M o <br /> C J <br /> m ys = <br /> 00 <br /> I <br /> SEE ATTACHED <br /> 1 N <br /> m <br /> 0 <br /> 0 <br /> J <br /> N <br /> O <br /> J <br /> O � <br /> w <br /> Vv <br /> W <br /> Z <br /> m O,c�Ln r­o a0- 0 <br /> m g� 2 a m >m M <br /> CONDITIONS OF PERMIT: m . Z $ J ,o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAY$'OF PERMIT ISSUANCE. o E o : : T'z <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =m: M <br /> 1 NO GRADING OR SHOP=LAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. b a �' O <br /> o : a� <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 informs- T <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that this infor- <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 /> further accept all liability whi h maybe a result of the County of Burnett relying on this information I am provitling in this ap. d, <br /> plication. I agree to permit county officials charged with administering county ordinances or other authorized person to have O N 0 <br /> access to the above describeJ premises at any reasonable time for the purpose of inspection. m 3 0 3c' <br /> m a n m <br /> r. _. _.. M..4, OO <br /> SIGN HERE wade R hhokrn <br /> (signature of owner or building contractor) �' I� I s E <br /> ZONING ADMINISTRATOR <br /> H H 6)H y1 6) -t <br /> TOWNSHIP PERMITS MAY BE REQUIRED j jo � $ m <br /> !boogo <br /> 000 oormp <br /> �— i <br />